Filippini Graziella, Falcone Chiara, Boiardi Amerigo, Broggi Giovanni, Bruzzone Maria G, Caldiroli Dario, Farina Rita, Farinotti Mariangela, Fariselli Laura, Finocchiaro Gaetano, Giombini Sergio, Pollo Bianca, Savoiardo Mario, Solero Carlo L, Valsecchi Maria G
Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
Neuro Oncol. 2008 Feb;10(1):79-87. doi: 10.1215/15228517-2007-038. Epub 2007 Nov 9.
Reliable data on large cohorts of patients with glioblastoma are needed because such studies differ importantly from trials that have a strong bias toward the recruitment of younger patients with a higher performance status. We analyzed the outcome of 676 patients with histologically confirmed newly diagnosed glioblastoma who were treated consecutively at a single institution over a 7-year period (1997-2003) with follow-up to April 30, 2006. Survival probabilities were 57% at 1 year, 16% at 2 years, and 7% at 3 years. Progression-free survival was 15% at 1 year. Prolongation of survival was significantly associated with surgery in patients with a good performance status, whatever the patient's age, with an adjusted hazard ratio of 0.55 (p < 0.001) or a 45% relative decrease in the risk of death. Radiotherapy and chemotherapy improved survival, with adjusted hazard ratios of 0.61 (p = 0.001) and 0.89 (p = 0.04), respectively, regardless of age, performance status, or residual tumor volume. Recurrence occurred in 99% of patients throughout the follow-up. Reoperation was performed in one-fourth of these patients but was not effective, whether performed within 9 months (hazard ratio, 0.86; p = 0.256) or after 9 months (hazard ratio, 0.98; p = 0.860) of initial surgery, whereas second-line chemotherapy with procarbazine, lomustine, and vincristine (PCV) or with temozolomide improved survival (hazard ratio, 0.77; p = 0.008). Surgery followed by radiotherapy and chemotherapy should be considered in all patients with glioblastoma, and these treatments should not be withheld because of increasing age alone. The benefit of second surgery at recurrence is uncertain, and new trials are needed to assess its effectiveness. Chemotherapy with PCV or temozolomide seems to be a reasonable option at tumor recurrence.
需要有关大量胶质母细胞瘤患者队列的可靠数据，因为此类研究与那些对招募年轻、体能状态较好的患者存在严重偏差的试验有很大不同。我们分析了676例经组织学确诊为新诊断胶质母细胞瘤的患者的预后情况，这些患者于1997年至2003年期间在一家机构连续接受治疗，并随访至2006年4月30日。1年生存率为57%，2年生存率为16%，3年生存率为7%。1年无进展生存率为15%。无论患者年龄如何，体能状态良好的患者生存时间的延长与手术显著相关，校正风险比为0.55（p < 0.001），即死亡风险相对降低45%。放疗和化疗可提高生存率，校正风险比分别为0.61（p = 0.001）和0.89（p = 0.04），与年龄、体能状态或残留肿瘤体积无关。在整个随访过程中，99%的患者出现复发。其中四分之一的患者接受了再次手术，但无效，无论再次手术是在初次手术后9个月内（风险比为 0.86；p = 0.256）还是9个月后（风险比为0.98；p = 0.860）进行，而采用丙卡巴肼、洛莫司汀和长春新碱（PCV）或替莫唑胺进行二线化疗可提高生存率（风险比为0.77；p = 0.008）。所有胶质母细胞瘤患者均应考虑手术联合放疗和化疗，不应仅因年龄增加而不给予这些治疗。复发时二次手术的益处尚不确定，需要新的试验来评估其有效性。肿瘤复发时，采用PCV或替莫唑胺化疗似乎是一个合理的选择。
