Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: The role of surgery
Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: The role of surgery
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DOI：
10.1136/jnnp.61.3.291
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发表时间：
1996-09-01
影响因子：
11
通讯作者：
Rossi, GF
中科院分区：
文献类型：
--
作者：
Scerrati, M;Roselli, R;Rossi, GF
1978年至1989年期间，对131例经手术治疗的低级别大脑半球胶质瘤（活检患者除外）进行了回顾性分析。未考虑丘脑、基底节、胼胝体或脑室位置。所有肿瘤均为世界卫生组织（WHO）II级胶质瘤：42例胶质细胞瘤和11例胶质细胞星形细胞瘤，49例少突胶质细胞瘤和29例少突星形细胞瘤。患者年龄14 ~ 63岁（平均32.9岁，中位34岁），Karnofsky评分0.50 ~ 0.90（平均80.7岁，中位80岁），术后随访24 ~ 190个月（平均97.02个月，中位93个月）。结果术后5年、8年、10年生存率分别为97.1%、76.1%、62.7%（中位生存时间144个月）。分析了以下变量对生存期的影响：年龄（< 20、21-40和> 40岁），Karnofsky评分（80-100，70，小于或等于70），组织学，肿瘤扩展（T1 < 3 cm，T2 3-5 cm，T3 > 5 cm最大直径），手术切除范围（S1根治性，S2部分< 10%残留肿瘤，S3部分-10%-50%残留肿瘤）和放疗（进行或不进行）。在单因素分析中，发现年龄组< 20岁与生存率显著正相关（P = 0.003），全切除和次全切除（S1和S2; P < 0.001）和非照射患者（P = 0.0049），而较短的生存概率，注意到双生细胞型星形细胞瘤（P < 0.001）和对于肿瘤延伸> 5cm（T3; P = 0.0193）。Karnofsky表现与生存率无显著相关性。在多变量分析影响生存的最相关因素是手术切除的程度，这导致作为唯一的变量保留一个显着的值（P = 0.001，风险因子= 2.20）。结论数据强烈支持的作用，手术切除尽可能广泛的治疗这些肿瘤。
Objective-To assess the role of surgery on survival of patients with grade II gliomas of the cerebral hemispheres.Methods-One hundred and thirty one low grade hemispheric gliomas surgically treated (biopsied patients excluded) between 1978 and 1989 were retrospectively reviewed. Thalamic, basal ganglia, callosal, or ventricular location were not considered. All tumours were World Health Organisation (WHO) grade II gliomas: 42 fibrillary and 11 gemistocytic astrocytomas, 49 oligodendrogliomas, and 29 oligoastrocytomas. Patients' ages ranged from 14 to 63 (mean 32.9, median 34) years, Karnofsky performance from 0.50 to 0.90 (mean 80.7, median 80), and postsurgical follow up of the living patients from 24 to 190 (mean 97.02, median 93) months. Postoperative external radiotherapy was performed in 49 cases.Results-The overall survival probability at five years was 97.1%, at eight years 76.1%, and at 10 years 62.7% (median survival time 144 months). The impact on survival of the following variables was analysed: age (< 20, 21-40, and > 40 years), Karnofsky score (80-100, 70, less than or equal to 70), histology, tumour extension (T1 < 3 cm, T2 3-5 cm, T3 > 5 cm maximum diameter), extent of surgical resection (S1 radical, S2 subtotal < 10% residual tumour, S3 partial-10%-50% residual tumour), and radiotherapy (either performed or not). A significant positive association with survival at univariate analysis was found for the age group < 20 years (P = 0.003), for total and subtotal surgical resections (S1 and S2; P < 0.001) and for the non-irradiated patients (P = 0.0049), whereas a shorter survival probability was noticed for gemistocytic astrocytomas (P < 0.001) and for tumour extension > 5 cm (T3; P = 0.0193). Karnofsky performance did not show any significant association with survival. The most relevant factor affecting survival at the multivariate analysis was the extent of surgical resection, which resulted as the only variable retaining a significant value (P = 0.001, risk factor = 2.20).Conclusions-The data strongly support the role of a surgical removal as extensive as possible in the treatment of these tumours.