Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis
Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis
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DOI：
10.1093/neuonc/nou349
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发表时间：
2015-06-01
期刊：
影响因子：
15.9
通讯作者：
Murty, Naresh K.
中科院分区：
文献类型：
--
作者：
Almenawer, Saleh A.;Badhiwala, Jetan H.;Murty, Naresh K.
背景。老年人高级别胶质瘤（HGGs）的最佳手术切除范围仍不确定，因为更广泛的切除程度带来的益处不明确，而且可能导致更高的死亡率和发病率。我们根据预先确定的方案进行了荟萃分析，并系统地检索了文献数据库中关于HGG提高采收率的报告。对接受活检、次全切除术（STR）和总全切除术（GTR）的老年患者（>= 60岁）的总生存期（OS）、术后karnofsky性能状态（KPS）、无进展生存期（PFS）、死亡率和发病率进行比较。使用随机效应模型确定治疗效果的汇总估计、平均差异（MDs）或相应95%置信区间（ci）的风险比（rr）。来自34项研究的12607名受试者符合入选标准，包括我们目前的211名患者。当比较整体切除（任何程度）和活检时，切除组的优势是OS （MD 3.88个月，95% CI: 2.14-5.62, P < 0.001）、术后KPS （MD 10.4, 95% CI: 6.58-14.22, P < 0.001）、PFS （MD 2.44个月，95% CI: 1.45-3.43, P < 0.001）、死亡率（RR = 0.27, 95% CI: 0.12-0.61, P = 0.002）和发病率（RR = 0.82, 95% CI: 0.46-1.46, P = 0.514）。GTR在OS方面显著优于STR (MD 3.77 mo, 95% CI: 2.26-5.29, P <。001)，术后KPS （MD 4.91, 95% CI: 0.91-8.92, P = 0.016）和PFS （MD 2.21个月，95% CI: 1.13-3.3, P < 0.001）。001)，死亡率（RR = 0.53, 95% CI: 0.05-5.71, P = 0.600）和发病率（RR = 0.52, 95% CI: 0.18-1.49, P = 0.223）无差异。我们的研究结果表明，随着安全切除程度的增加，生存时间、功能恢复和肿瘤复发率都有所提高。如果在管理携带hgg的老年患者时将这些益处与已知的既定安全措施结合考虑，则不会导致更高的死亡率或发病率。
Background. Optimal extent of surgical resection (EOR) of high-grade gliomas (HGGs) remains uncertain in the elderly given the unclear benefits and potentially higher rates of mortality and morbidity associated with more extensive degrees of resection.Methods. We undertook a meta-analysis according to a predefined protocol and systematically searched literature databases for reports about HGG EOR. Elderly patients (>= 60 y) undergoing biopsy, subtotal resection (STR), and gross total resection (GTR) were compared for the outcome measures of overall survival (OS), postoperative karnofsky performance status (KPS), progression-free survival (PFS), mortality, and morbidity. Treatment effects as pooled estimates, mean differences (MDs), or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were determined using random effects modeling.Results. A total of 12 607 participants from 34 studies met eligibility criteria, including our current cohort of 211 patients. When comparing overall resection (of any extent) with biopsy, in favor of the resection group were OS (MD 3.88 mo, 95% CI: 2.14-5.62, P < .001), postoperative KPS (MD 10.4, 95% CI: 6.58-14.22, P < .001), PFS (MD 2.44 mo, 95% CI: 1.45-3.43, P < .001), mortality (RR = 0.27, 95% CI: 0.12-0.61, P = .002), and morbidity (RR = 0.82, 95% CI: 0.46-1.46, P = .514). GTR was significantly superior to STR in terms of OS (MD 3.77 mo, 95% CI: 2.26-5.29, P < . 001), postoperative KPS (MD 4.91, 95% CI: 0.91-8.92, P = .016), and PFS (MD 2.21 mo, 95% CI: 1.13-3.3, P < . 001) with no difference in mortality (RR = 0.53, 95% CI: 0.05-5.71, P = .600) or morbidity (RR = 0.52, 95% CI: 0.18-1.49, P = .223).Conclusions. Our findings suggest an upward improvement in survival time, functional recovery, and tumor recurrence rate associated with increasing extents of safe resection. These benefits did not result in higher rates of mortality or morbidity if considered in conjunction with known established safety measures when managing elderly patients harboring HGGs.