Schmidt Meic H, Berger Mitchel S, Lamborn Kathleen R, Aldape Ken, McDermott Michael W, Prados Michael D, Chang Susan M
Department of Neurological Surgery, University of California at San Francisco, California, USA.
J Neurosurg. 2003 Jun;98(6):1165-9. doi: 10.3171/jns.2003.98.6.1165.
Progression of infiltrative low-grade gliomas (LGGs) has been reported previously. The limitations of such studies include diverse histological grading systems, intervening therapy, and the lack of histological confirmation of malignant tumor progression. The aim of this study was to determine tumor progression in adult patients with an initial diagnosis of infiltrative LGG who subsequently underwent a repeated operation, but no other intervening therapy. The authors examined factors that may be associated with tumor progression.
The authors retrospectively reviewed a database of 300 patients with the initial diagnosis of LGG and who had been treated at their institution between 1990 and 2000. One hundred four of these patients had undergone a second surgery. Patients with infiltrative LOGs who had undergone two surgical procedures at least 3 months apart without intervening therapy were selected; the authors identified 40 patients who fit these criteria. Clinical, neuroimaging, and pathological data were centrally reviewed. There were 29 men and 11 women in the study, whose median age was 35.5 years (range 23-48 years). At the time of the second surgery, 50% of patients had experienced tumor progression. Patients whose tumors had progressed had a longer median time to repeated operation (49 compared with 22.5 months). Patients who had undergone gross-total resection, as demonstrated on postoperative magnetic resonance images, had a median time to repeated operation of 49 compared with 25 and 24 months in patients who underwent subtotal resection and biopsy, respectively (p = 0.02). The extent of resection did not influence the likelihood of tumor progression (p > 0.3).
Fifty percent of patients with initially diagnosed infiltrative LGOs had tumor progression at the time of a repeated operation. A gross-total resection was associated with an increased time to repeated surgery. There was no statistically significant effect of gross-total resection as a predictor of tumor progression.
先前已有关于浸润性低级别胶质瘤（LGG）进展的报道。此类研究的局限性包括组织学分级系统多样、存在干预性治疗以及缺乏恶性肿瘤进展的组织学确认。本研究的目的是确定最初诊断为浸润性LGG且随后接受了再次手术但未接受其他干预性治疗的成年患者的肿瘤进展情况。作者研究了可能与肿瘤进展相关的因素。
作者回顾性分析了1990年至2000年间在其机构接受治疗的300例最初诊断为LGG患者的数据库。其中104例患者接受了二次手术。选择至少间隔3个月接受了两次手术且未接受干预性治疗的浸润性LGG患者；作者确定了40例符合这些标准的患者。对临床、神经影像学和病理数据进行集中审查。本研究中有29名男性和11名女性，中位年龄为35.5岁（范围23 - 48岁）。在二次手术时，50%的患者出现了肿瘤进展。肿瘤进展的患者再次手术的中位时间更长（分别为49个月和22.5个月）。术后磁共振成像显示接受了全切术的患者再次手术的中位时间为49个月，而接受次全切术和活检的患者分别为25个月和24个月（p = 0.02）。切除范围不影响肿瘤进展的可能性（p > 0.3）。
最初诊断为浸润性LGG的患者中有50%在再次手术时出现肿瘤进展。全切术与再次手术时间的延长相关。全切术作为肿瘤进展预测指标无统计学显著影响。
