Parsa Andrew T, Wachhorst Scott, Lamborn Kathleen R, Prados Michael D, McDermott Michael W, Berger Mitchel S, Chang Susan M
Department of Neurological Surgery, School of Medicine, University of California at San Francisco, California 94143, USA.
J Neurosurg. 2005 Apr;102(4):622-8. doi: 10.3171/jns.2005.102.4.0622.
The clinical outcome and treatment of adult patients with disseminated intracranial glioblastoma multiforme (GBM) is unclear. The objective in the present study was to assess the prognostic significance of disseminated intracranial GBM in adults at presentation and at the time of tumor progression.
Clinical data from 1491 patients older than 17 years and harboring a GBM that had been diagnosed between 1988 and 1998 at the University of California at San Francisco neurooncology clinic were retrospectively reviewed. Dissemination of the GBM (126 patients) was determined based on Gd-enhanced magnetic resonance images. Classification of dissemination was as follows: Type I, single lesion with subependymal or subarachnoid spread; Type II, multifocal lesions without subependymal or subarachnoid spread; and Type III, multifocal lesions with subependymal or subarachnoid spread. Subgroups of patients were compared using Kaplan-Meier curves that depicted survival probability. The median postprogression survival (PPS), defined according to neuroimaging demonstrated dissemination, was 37 weeks for Type I (23 patients), 25 weeks for Type II (50 patients), and 10 weeks for Type III spread (19 patients). Patients with dissemination at first tumor progression (52 patients) overall had a shorter PPS than those in a control group with local progression, after adjusting for age, Kamofsky Performance Scale score, and time from tumor diagnosis to its progression (311 patients). When analyzed according to tumor dissemination type, PPS was significantly shorter in patients with Type II (33 patients, p < 0.01) and Type III spread (11 patients, p < 0.01) but not in those with Type I spread (eight patients, p = 0.18).
Apparently, the presence of intracranial tumor dissemination on initial diagnosis does not in itself preclude aggressive treatment if a patient is otherwise well. A single focus of GBM that later demonstrates Type I dissemination on progression does not have a worse prognosis than a lesion that exhibits only local recurrence.
成人弥漫性颅内多形性胶质母细胞瘤（GBM）的临床结局及治疗情况尚不清楚。本研究的目的是评估成人患者初诊时及肿瘤进展时弥漫性颅内GBM的预后意义。
回顾性分析1988年至1998年在加利福尼亚大学旧金山分校神经肿瘤诊所确诊为GBM的1491例17岁以上患者的临床资料。根据钆增强磁共振成像确定GBM的播散情况（126例患者）。播散分类如下：I型，单个病灶伴室管膜下或蛛网膜下播散；II型，多灶性病灶无室管膜下或蛛网膜下播散；III型，多灶性病灶伴室管膜下或蛛网膜下播散。使用描绘生存概率的Kaplan-Meier曲线对患者亚组进行比较。根据神经影像学显示的播散情况定义的进展后中位生存期（PPS），I型（23例患者）为37周，II型（50例患者）为25周，III型播散（19例患者）为10周。在调整年龄、卡氏功能状态评分以及从肿瘤诊断到进展的时间后，首次肿瘤进展时出现播散的患者（52例）总体PPS比局部进展的对照组患者（311例）短。根据肿瘤播散类型分析时，II型（33例患者，p<0.01）和III型播散（1例患者，p<0.01）患者的PPS显著较短，但I型播散患者（8例患者，p=0.18）并非如此。
显然，如果患者其他情况良好，初诊时颅内肿瘤播散的存在本身并不排除积极治疗。最初表现为单个病灶的GBM，进展时显示I型播散，其预后并不比仅表现为局部复发的病灶差。
