Evaluating extent of resection in pediatric glioblastoma: a multiple propensity score-adjusted population-based analysis
Evaluating extent of resection in pediatric glioblastoma: a multiple propensity score-adjusted population-based analysis
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DOI：
10.1007/s00381-015-3006-x
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发表时间：
2016-03-01
影响因子：
1.4
通讯作者：
Quinones-Hinojosa, Alfredo
中科院分区：
文献类型：
--
作者：
Adams, Hadie;Adams, Hieab H. H.;Quinones-Hinojosa, Alfredo
根治性切除对胶质母细胞瘤患者的益处仍然是文献中争论的来源。在儿科患者中进行的研究很少，而且越来越明显的是，关于成人胶质母细胞瘤(GB)患者的数据不能推广到受这种肿瘤影响的儿科患者。在儿科GB(PGB)患者的最大队列中，对不同的切除范围(EOR)组进行了有效性比较研究。1988年至2009年，使用监测、流行病学和最终结果(SEER)癌症登记来确定PGB患者。采用多变量和多倾向性评分(MPS)调整分析来确定大部切除(GTR)、部分切除(PR)和活检(Bx)对总生存率的影响。通过直接调整生存曲线总结生存前景。共有342名PGB患者被确定，其中35.4%的患者接受了GTR术，28.8%的患者接受了PR，17.3%的患者接受了Bx手术，17.0%的患者没有接受手术。在我们的队列中，中位总生存期为12个月，1、2和5年生存率分别为51.7%、28.3%和15.7%。在多变量模型(P<；0.001)和MPS调整模型(P<；0.001)中，EOR都是生存的预测因子。与GTR组相比，接受PR(HR 1.50；95%CI，1.02-2.21)或Bx(HR 1.87；95%CI，1.18-2.98)的患者死亡率更高。PR组和Bx组之间(调整后的)死亡风险没有显著差异。我们的研究表明，GTR与改善儿童胶质母细胞瘤患者的存活率独立相关。
The benefit of radical resections for glioblastoma patients remains a source of contention in the literature. Few studies have been conducted in pediatric patients, and it is becoming increasingly evident that data regarding adult glioblastoma (GB) patients cannot be generalized to pediatric patients affected by this neoplasm. A comparative effectiveness study is performed for different extent of resection (EOR) groups in the largest cohort of pediatric GB (pGB) patients.The Surveillance, Epidemiology, and End Results (SEER) cancer registry was used to identify pGB patients from 1988 through 2009. Multivariate- and multiple propensity score (mPS)-adjusted analyses were used to determine the effect of gross total resection (GTR), partial resection (PR), and biopsy (Bx) on overall survival. Survival prospects were summarized using direct adjusted survival curves.A total of 342 pGB patients were identified, and 35.4 % of patients received a GTR, 28.8 % PR, 17.3 % Bx, and 17.0 % did not undergo surgery. In our cohort, a median overall survival of 12 months was observed with 1-, 2-, and 5-year survival rates of 51.7, 28.3, and 15.7 %, respectively. EOR was a predictor of survival in both the multivariate- (P < 0.001) and mPS-adjusted model (P < 0.001). Compared to the GTR group, a higher mortality rate was observed in patients who underwent a PR (HR 1.50; 95 % CI, 1.02-2.21) or Bx (HR 1.87; 95 % CI, 1.18-2.98). There were no significant differences in (adjusted) mortality risk between the PR and Bx groups.Our study suggests that GTR is independently associated with improved survival for pediatric patients with glioblastoma.