Stupp Roger, Janzer Robert C, Hegi Monika E, Villemure Jean-Guy, Mirimanoff René O
Multidisciplinary Oncology Center, University Hospital (CHUV), 46, Rue du Bugnon, CH-1011 Lausanne, Switzerland.
Semin Oncol. 2003 Dec;30(6 Suppl 19):23-8. doi: 10.1053/j.seminoncol.2003.11.029.
Low-grade gliomas are a heterogenous group of diseases characterized by relatively slow-growing primary brain tumors of astrocytic and/or oligodendroglial origin. Many patients present with easily controlled seizures and remain stable for years, whereas others progress rapidly to higher-grade tumors. Several studies have retrospectively investigated tumor-, patient-, and treatment-related prognostic factors in this patient population. Tumor histology, grade, location, contrast enhancement, and molecular markers have been identified as prognostic factors for survival. Likewise, patient age, performance status, and seizure history are patient-dependent prognostic factors. However, although patients who undergo surgical resection and receive adjuvant radiotherapy tend to have improved survival, treatment-dependent prognostic factors have yet to be definitively identified. Recursive partitioning and multivariant analyses have identified a class of patients with good prognosis. Younger patients with good performance status, non-contrast-enhancing tumors (<5 cm), and tumors of oligodendroglial or mixed-oligoastrocytic subtype have improved survival. The European Organisation for Research and Treatment of Cancer has recently developed a prognostic score based on identified prognostic factors to assist in the management of low-grade gliomas. For patients with a favorable (low-risk) score, treatment with radiotherapy or chemotherapy treatment should be withheld until tumor progression. For patients with a high-risk score, treatment at diagnosis may be indicated. However, other than surgery, the optimal types and sequence of therapies are not yet established. Improvements in defining prognostic factors will assist in low-grade glioma management.
低级别胶质瘤是一组异质性疾病，其特征为起源于星形细胞和/或少突胶质细胞的原发性脑肿瘤生长相对缓慢。许多患者表现为易于控制的癫痫发作，且多年病情稳定，而其他患者则迅速进展为高级别肿瘤。多项研究对该患者群体中与肿瘤、患者及治疗相关的预后因素进行了回顾性调查。肿瘤组织学、分级、位置、强化情况及分子标志物已被确定为生存的预后因素。同样，患者年龄、身体状况及癫痫病史是取决于患者的预后因素。然而，尽管接受手术切除并接受辅助放疗的患者生存期往往有所改善，但与治疗相关的预后因素尚未明确确定。递归划分和多变量分析已确定了一类预后良好的患者。年轻、身体状况良好、无强化肿瘤（<5厘米）以及少突胶质细胞或少突星形细胞混合亚型肿瘤的患者生存期有所改善。欧洲癌症研究与治疗组织最近基于已确定的预后因素制定了一个预后评分系统，以协助低级别胶质瘤的管理。对于预后良好（低风险）评分的患者，应在肿瘤进展前暂缓放疗或化疗。对于高风险评分的患者，可能需要在诊断时进行治疗。然而，除手术外，最佳的治疗类型和顺序尚未确定。明确预后因素方面的进展将有助于低级别胶质瘤的管理。
