Scott J N, Rewcastle N B, Brasher P M, Fulton D, MacKinnon J A, Hamilton M, Cairncross J G, Forsyth P
Department of Diagnostic Imaging, University of Calgary, Alberta, Canada.
Ann Neurol. 1999 Aug;46(2):183-8.
In this clinical and histopathological study, the frequency of long-term glioblastoma multiforme (GBM) survivors (LTGBMSs) was determined in a population-based study. The Alberta Cancer Registry was used to identify all patients diagnosed with GBM in Alberta between January 1, 1975, and December 31, 1991. Patient charts were reviewed and histology reexamined. LTGBMSs were defined as GBM patients surviving 3 years after diagnosis. Each LTGBMS was compared with 3 age-, sex-, and year of diagnosis-matched controls, and patient/treatment or tumor characteristics that predicted long-term survival were determined. There were 689 GBMs diagnosed in the study period; 15 (2.2%) of these patients survived 3 years. LTGBMSs (average age, 43.5 +/- 3.3 years) were significantly younger when compared with all GBM patients (average age, 53.0 +/- 0.56 years). LTGBMSs had a higher Karnofsky Performance Status score at diagnosis compared with controls. LTGBMSs were much more likely to have had a gross total resection and adjuvant chemotherapy than control GBM patients. Tumors from LTGBMSs tended to have fewer mitoses and a significantly lower Ki-67 cellular proliferation index compared with controls. Radiation-induced dementia was common and disabling in LTG-BMSs. In conclusion, conventionally treated GBM patients in an unselected population have a very small chance of long-term survival. The use of aggressive surgical resection and adjuvant chemotherapy may make long-term survival more likely in GBM patients if their performance status is high at diagnosis.
在这项临床和组织病理学研究中，在一项基于人群的研究中确定了多形性胶质母细胞瘤（GBM）长期存活者（LTGBMS）的频率。利用艾伯塔癌症登记处来识别1975年1月1日至1991年12月31日期间在艾伯塔被诊断为GBM的所有患者。查阅了患者病历并重新检查了组织学。LTGBMS被定义为诊断后存活3年的GBM患者。将每位LTGBMS与3名年龄、性别和诊断年份相匹配的对照进行比较，并确定预测长期存活的患者/治疗或肿瘤特征。在研究期间共诊断出689例GBM；其中15例（2.2%）患者存活了3年。与所有GBM患者（平均年龄53.0±0.56岁）相比，LTGBMS（平均年龄43.5±3.3岁）明显更年轻。与对照组相比，LTGBMS在诊断时的卡氏功能状态评分更高。与对照GBM患者相比，LTGBMS更有可能进行了全切除和辅助化疗。与对照组相比，LTGBMS的肿瘤往往有较少的有丝分裂，且Ki-67细胞增殖指数显著更低。放射性痴呆在LTG-BMS中很常见且会导致残疾。总之，在未经选择的人群中接受传统治疗的GBM患者长期存活的机会非常小。如果GBM患者在诊断时功能状态良好，积极的手术切除和辅助化疗的使用可能使他们更有可能长期存活。
