McCormack B M, Miller D C, Budzilovich G N, Voorhees G J, Ransohoff J
Department of Neurosurgery, New York University Medical Center, New York.
Neurosurgery. 1992 Oct;31(4):636-42; discussion 642. doi: 10.1227/00006123-199210000-00004.
A retrospective review of the records of the Division of Neuropathology at the New York University Medical Center between 1977 and 1988 revealed 53 cases of adult supratentorial astrocytomas. Fifty were fibrillary, and three were gemistocytic. Two additional patients had pilocytic tumors and were not included in the study. The majority of patients had either a subtotal (64%) or gross total resection (19%). Biopsy (17%) was performed for deep-seated lesions and for those lesions confined to eloquent cortex. Forty-eight patients (91%) received postoperative radiation therapy. The median survival was 7 1/4 years with a 5-year survival of 64%. Multivariate regression analysis demonstrated that the most important prognosticators for improved survival were young age, absence of contrast enhancement of the original tumor on computed tomography (CT) and the performance status of the patient. Patients with hemispheric tumors died from dedifferentiation into an anaplastic astrocytoma or a glioblastoma multiforme, with a median time to recurrence of 4.5 years from the original surgery. Survival from the time of recurrence was 12 months. Subsequent operations confirmed progression towards malignancy in six of seven (86%) recurrent tumors. CT contrast enhancement of the original tumor was associated with a 6.8-fold increase in risk for later recurrence. Patients with thalamic tumors (six patients) had a poor prognosis with a median survival of less than 2 years. A review of their CT scans suggest that four died of progressive low-grade disease; however, confirmatory autopsy data were available for only one patient. This study supports others that have shown improved survival for adult patients with astrocytomas treated in the CT era.
对纽约大学医学中心神经病理学部门1977年至1988年间的记录进行回顾性研究，发现了53例成人幕上星形细胞瘤。其中50例为纤维型，3例为肥胖细胞型。另外两名患者患有毛细胞型肿瘤，未纳入本研究。大多数患者接受了次全切除（64%）或全切除（19%）。对于深部病变和局限于明确皮层的病变，进行了活检（17%）。48例患者（91%）接受了术后放疗。中位生存期为7.25年，5年生存率为64%。多变量回归分析表明，改善生存的最重要预后因素是年轻、计算机断层扫描（CT）上原肿瘤无强化以及患者的功能状态。半球肿瘤患者死于肿瘤去分化为间变性星形细胞瘤或多形性胶质母细胞瘤，从初次手术到复发的中位时间为4.5年。复发后的生存期为12个月。后续手术证实，七例复发肿瘤中有六例（86%）向恶性进展。原肿瘤的CT强化与后期复发风险增加6.8倍相关。丘脑肿瘤患者（6例）预后较差，中位生存期不到2年。对他们CT扫描的回顾表明，4例死于进行性低级别疾病；然而，只有1例患者有确诊的尸检数据。本研究支持其他研究结果，即在CT时代治疗的成人星形细胞瘤患者生存率有所提高。
