Hanzély Zoltán, Polgár Csaba, Fodor János, Brucher Jean-Marie, Vitanovics Dusán, Mangel László Csaba, Afra Dénes
Department of Neuropathology, National Institute of Neurosurgery, Budapest, Hungary.
J Neurooncol. 2003 Jul;63(3):305-12. doi: 10.1023/a:1024376719067.
To determine principal prognostic factors and the effect of timing of radiotherapy (RT) on disease-specific survival (DSS) and progression-free survival (PFS) in WHO Grade II astrocytomas.
Histologic slides of 166 consecutive patients with the original tissue diagnosis of low-grade, non-pilocytic astrocytoma were reviewed. One-hundred and six were selected where two additional certified neuropathologist agreed on the grading of WHO Grade II astrocytoma. In 97 out of 106 cases follow-up informations were available. Early postoperative RT was given to 36 out of 97 patients (37%). The two groups of patients (early vs. delayed RT) were well balanced in respect to extent of surgery and other main clinical prognostic factors. Median follow-up of surviving patients was 79 months. The 5- and 10-year PFS was 52.2% and 30.7% with early RT and 39.5% and 12.4% with delayed RT (p = 0.0388). In respect to DSS, there was no significant difference in the 5- and 10-year actuarial survival rate according to the timing of RT (60.5% and 26.5% vs. 66.6% and 23.7%; p = 0.7545). Age (p = 0.0145) and extent of surgery (p = 0.0473) were significant prognostic variables in respect to DSS. Subdividing the irradiated group based on the extent of surgery, early RT in the subtotal group significantly improved 5-year PFS (60.0% vs. 12.4%; p = 0.0036) and DSS (66.7% vs. 49.8%; p = 0.0389). However, postoperative RT had no influence on PFS (p = 0.6812) and DSS (p = 0.3987) in the group with extensive resection.
Early postoperative RT in subtotally resected, Grade II astrocytomas significantly improves both progression-free and disease-specific survival. Early RT does not benefit patients with extensive resection, RT should be withheld in these patients until progression.
确定世界卫生组织（WHO）二级星形细胞瘤的主要预后因素以及放疗（RT）时机对疾病特异性生存（DSS）和无进展生存（PFS）的影响。
回顾了166例最初组织诊断为低级别、非毛细胞型星形细胞瘤患者的组织学切片。在另外两名经认证的神经病理学家对WHO二级星形细胞瘤分级达成一致的情况下，选取了106例患者。106例患者中有97例可获得随访信息。97例患者中有36例（37%）在术后早期接受了放疗。两组患者（早期放疗与延迟放疗）在手术范围和其他主要临床预后因素方面均衡良好。存活患者的中位随访时间为79个月。早期放疗组的5年和10年无进展生存率分别为52.2%和30.7%，延迟放疗组分别为39.5%和12.4%（p = 0.0388）。关于疾病特异性生存，根据放疗时机，5年和10年精算生存率无显著差异（60.5%和26.5%对比66.6%和23.7%；p = 0.7545）。年龄（p = 0.0145）和手术范围（p = 0.0473）是疾病特异性生存的显著预后变量。根据手术范围对放疗组进行细分，次全切除组的早期放疗显著提高了5年无进展生存率（60.0%对比12.4%；p = 0.0036）和疾病特异性生存率（66.7%对比49.8%；p = 0.0389）。然而，在广泛切除组中，术后放疗对无进展生存（p = 0.6812）和疾病特异性生存（p = 0.3987）没有影响。
次全切除的二级星形细胞瘤术后早期放疗可显著提高无进展生存率和疾病特异性生存率。早期放疗对广泛切除的患者无益处，这些患者应在疾病进展前暂不放疗。
