Usefulness of Reintervention in Recurrent Glioblastoma: An Indispensable Weapon for Increasing Survival
Usefulness of Reintervention in Recurrent Glioblastoma: An Indispensable Weapon for Increasing Survival
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DOI：
10.1016/j.wneu.2017.09.062
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发表时间：
2017-12-01
影响因子：
2
通讯作者：
Sola, Rafael G.
中科院分区：
文献类型：
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作者：
Delgado-Fernandez, Juan;Angeles Garcia-Pallero, Maria;Sola, Rafael G.
背景：胶质母细胞瘤是最常见的原发性脑肿瘤，尽管完全治疗，生存率仍然很低。本研究的目的是确定再次手术对提高复发性胶质母细胞瘤患者生存率的作用，并确定与延长生存率相关的其他预后因素。方法：我们对接受手术的患者进行回顾性分析，并将两次或两次以上手术的患者与仅接受一次手术的患者进行比较。我们研究了总生存期（OS）、无进展生存期（PFS）和可能与高生存期相关的临床变量。结果：共有121例患者符合研究条件，其中31例（25%）再次手术。与不手术组相比，再手术组OS的平均和中位生存期分别增加10.5和16.4个月，PFS的平均和中位生存期分别增加3.5和2.7个月（P分别< 0.001和0.01）。虽然再干预组的并发症发生率较高（19.3%），但首次手术组的并发症发生率无统计学差异(12.4%,chi(2) = 1.86；P = 0.40)。Cox多变量分析显示，年龄（风险比[HR] 1.03, 95%可信区间[CI] 1.006-1.055, P = 0.013）、再手术（HR, 0.48, 95% CI, 0.285-0.810, P = 0.006）、切除程度（HR, 0.547, 95% CI, 0.401-0.748, P < 0.001）、完全辅助治疗（HR, 0.389, 95% CI, 0.208-0.726, P = 0.003）与较高的OS相关。结论：再手术和切除程度（EOR）是神经外科医生可以改变的唯一手术变量，以提高患者的生存率。高EOR和再手术率的患者可以选择第二次手术，将增加OS和PFS。
BACKGROUND: Glioblastoma is the most frequent primary brain tumor and despite of complete treatment survival is still poor. The aim of this study is to define the utility of reoperation for improving survival in patients with recurrent glioblastoma, and determine other prognostic factors associated with longer survival.METHODS: We performed a retrospective analysis of those patients who underwent surgery and compared those who were operated two or more times and those who received surgery only once. We studied overall survival (OS), progression-free survival (PFS), and clinical variables that could be related with higher survival.RESULTS: A total of 121 patients were eligible for the study, of whom 31 (25%) underwent reoperation. The reoperation group had a mean and median increase survival of 10.5 and 16.4 months in OS and 3.5 and 2.7 months for PFS compared with the non-reoperation group (P < 0.001 and 0.01, respectively). Although complications were higher in patients that underwent reintervention (19.3%) there was no statistical difference with complication rate in first surgery (12.4%, chi(2) = 1.86; P = 0.40). Cox multivariable analysis revealed that age (hazard ratio [HR] 1.03; 95% confidence interval [CI], 1.006-1.055; P = 0.013), reoperation (HR, 0.48; 95% CI, 0.285-0.810; P = 0.006), extent of resection >95% (HR, 0.547; 95% CI, 0.401-0.748; P < 0.001), and complete adjuvant therapy (HR, 0.389; 95% CI, 0.208-0.726; P = 0.003) were correlated with a higher OS.CONCLUSIONS: Reoperation and the extent of resection (EOR) are the only surgical variables that neurosurgeons can modify to improve survival in our patients. Higher EOR and reoperation rates in patients who can be candidates for second surgery, will increase OS and PFS.