Prognostic paradox: brain damage around the glioblastoma resection cavity
Prognostic paradox: brain damage around the glioblastoma resection cavity
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DOI：
10.1007/s11060-014-1418-1
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发表时间：
2014-05-01
影响因子：
3.9
通讯作者：
Hamada, Jun-ichiro
中科院分区：
文献类型：
--
作者：
Furuta, Takuya;Nakada, Mitsutoshi;Hamada, Jun-ichiro
脑肿瘤手术后，由于周围脑组织的损害，磁共振弥散加权成像（MR-DWI）常出现切除腔周围的高信号病灶。探讨胶质母细胞瘤（GBM）患者的病变和预后之间的假定联系。这项回顾性研究回顾了连续61例新诊断的GBM患者。首次手术后2周内进行术后MRI。我们根据是否观察到DWI高信号病变将病例分为两组[DWI（+）组和DWI（-）组]。比较两组患者的无进展生存期（PFS）和总生存期（OS）。确定了42名患者。28/42例（66.7%）切除腔周围可见不同程度的高信号灶.在DWI（+）和DWI（-）组中，中位PFS分别为10.0 [95%置信区间（CI）8.4-11.5]和6.7（95% CI 4.9-8.5）个月（p = 0.042），中位OS分别为18.0（95% CI 12.2-23.8）和17.0（95% CI 15.7-18.3）个月（p = 0.254）。在多变量分析中，DWI高信号病变的存在更可能是6个月PFS的独立预测因素（p = 0.019; HR，0.038; 95% CI 0.002-0.582）。肿瘤复发出现在前DWI高信号病变之外。MR-DWI上切除的GBM周围高信号病变可能是GBM患者的有利预后因素。
Hyperintense lesions around the resection cavity on magnetic resonance diffusion-weighted imaging (MR-DWI) frequently appear after brain tumor surgery due to the damage of surrounding brain. The putative connection between the lesion and the prognosis for patients with glioblastoma (GBM) was explored. This retrospective study reviewed consecutive sixty-one patients with newly diagnosed GBM. Postoperative MRI was performed within 2 weeks after the initial surgery. We classified the cases into two groups depending on whether DWI hyperintense lesions were observed or not [DWI(+) group and DWI(-) group]. Progression-free survival (PFS) and overall survival (OS) were compared between the two groups. Forty-two patients were identified. The various extents of hyperintense lesions around the resection cavity were observed in 28/42 (66.7 %) cases. In the DWI(+) and DWI(-) groups, median PFS was 10.0 [95 % confidence interval (CI) 8.4-11.5] and 6.7 (95 % CI 4.9-8.5) months, respectively (p = 0.042), and median OS was 18.0 (95 % CI 12.2-23.8) and 17.0 (95 % CI 15.7-18.3) months, respectively (p = 0.254). On multivariate analysis, the presence of DWI hyperintense lesion was more likely to be an independent predictor for 6-month PFS (p = 0.019; HR, 0.038; 95 % CI 0.002-0.582). Tumor recurrence appeared outside the former DWI hyperintense lesion. Hyperintense lesions surrounding the resected GBM on MR-DWI might be a favorable prognostic factor in patients with GBM.