Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project
Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project
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DOI：
10.3171/jns.2003.99.3.0467
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发表时间：
2003-09-01
影响因子：
4.1
通讯作者：
Chang, S
中科院分区：
文献类型：
--
作者：
Laws, ER;Parney, IF;Chang, S
Object.胶质瘤结局项目代表了对北美恶性（III级和IV级/GBM）胶质瘤管理的当代分析。该观察性数据库用于评价切除术（而非活检）对患者预后的影响（通过生存时间测量）。尝试通过在忽略具有主要负预后因素的患者后重复数据分析来减少选择偏倚的影响。我们分析了来自多个研究中心的788例患者在4年期间（1997-2001）的结局数据，主要结局指标为生存时间。其中，565例近期诊断的患者构成了本分析的基础。患者系统随访至死亡或入组研究后24个月，生存数据与肿瘤的组织病理学分级和位置、手术范围、患者的体能状态和人口统计学因素相关，近期诊断GBM患者的中位生存期为40.9周。III级胶质瘤患者的真实中位生存期尚未达到，尽管104周时的生存率为58%。在多变量分析中，切除而不是活检（p < 0.0001），年龄60岁或以下（p < 0.0001），Karnofsky性能量表（KPS）评分70或以上（p = 0.0004）与III或IV级胶质瘤患者的生存时间延长相关。切除术与活检术相比的预后价值仍然存在（p < 0.0001），即使排除了被认为是“低风险”的患者（年龄> 60岁，KPS评分< 70，或存在多灶性肿瘤），这些患者在活检组中的代表性可能过高。III级胶质瘤和GBM的24个月生存率分别为58%和11%。这些数据提供了11级证据，支持肿瘤分级、患者年龄和患者功能状态作为最近诊断出恶性胶质瘤的患者生存的预后因素。切除（与活检相比）也是一个强有力的预后因素;然而，没有定量的尝试来评估切除的真实范围。
Object. The Glioma Outcomes Project represents a contemporary analysis of the management of malignant (Grade III and Grade IV/GBM) gliomas in North America. This observational database was used to evaluate the influence of resection, as opposed to biopsy, on patient outcome as measured by the length of survival. Attempts were made to reduce the impact of selection bias by repeating the data analysis after omitting patients with major negative prognostic factors.Methods. Outcome data from 788 patients accrued from multiple sites over a 4-year period (1997-2001) were analyzed with the primary outcome measure being length of survival. Of these, 565 patients with recent diagnoses formed the basis of the present analysis. Patients were systematically followed up until death or up to 24 months after enrollment in the study, and survival data were correlated with the histopathological grade and location of the tumor, the extent of surgery, the patient's performance status, and demographic factors.The median length of survival was 40.9 weeks for patients with recently diagnosed GBMs. The true median length of survival for patients with Grade Ill gliomas was not reached, although there was a 58% survival rate at 104 weeks. In multivariate analysis, resection rather than biopsy (p < 0.0001), age 60 years or younger (p < 0.0001), and a Karnofsky Performance Scale (KPS) score of 70 or greater (p = 0.0004) were associated with a prolonged survival time for patients with Grade III or IV gliomas. The prognostic value of resection compared with biopsy was maintained (p < 0.0001), even after eliminating patients considered to be "poor risk" (those with age > 60 years, KPS score < 70, or presence of multifocal tumors), who may have been overrepresented in the biopsy group. Survival "tails" at 24 months were 58% for Grade III gliomas and 11% for GBMs.Conclusions. These data provide Class 11 evidence to support tumor grade, patient's age, and patient's functional status as prognostic factors for survival in individuals with recently diagnosed malignant gliomas. Resection (compared with biopsy) is also a strong prognostic factor; however, no quantitative attempt was made to assess the true extent of the resection.