切除范围在低级别半球胶质瘤长期预后中的作用。

Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas.

作者信息

Smith Justin S, Chang Edward F, Lamborn Kathleen R, Chang Susan M, Prados Michael D, Cha Soonmee, Tihan Tarik, Vandenberg Scott, McDermott Michael W, Berger Mitchel S

机构信息

Department of Neurological Surgery, Brain Tumor Research Center, University of California San Francisco, 505 Parnassus Ave, Room M-779, San Francisco, CA 94143-0112, USA.

出版信息

J Clin Oncol. 2008 Mar 10;26(8):1338-45. doi: 10.1200/JCO.2007.13.9337.

DOI:10.1200/JCO.2007.13.9337

PMID:18323558

Abstract

PURPOSE

The prognostic role of extent of resection (EOR) of low-grade gliomas (LGGs) is a major controversy. We designed a retrospective study to assess the influence of EOR on long-term outcomes of LGGs.

PATIENTS AND METHODS

The study population (N = 216) included adults undergoing initial resection of hemispheric LGG. Region-of-interest analysis was performed to measure tumor volumes based on fluid-attenuated inversion-recovery (FLAIR) imaging.

RESULTS

Median preoperative and postoperative tumor volumes and EOR were 36.6 cm(3) (range, 0.7 to 246.1 cm(3)), 3.7 cm(3) (range, 0 to 197.8 cm(3)) and 88.0% (range, 5% to 100%), respectively. There was no operative mortality. New postoperative deficits were noted in 36 patients (17%); however, all but four had complete recovery. There were 34 deaths (16%; median follow-up, 4.4 years). Progression and malignant progression were identified in 95 (44%) and 44 (20%) cases, respectively. Patients with at least 90% EOR had 5- and 8-year overall survival (OS) rates of 97% and 91%, respectively, whereas patients with less than 90% EOR had 5- and 8-year OS rates of 76% and 60%, respectively. After adjusting each measure of tumor burden for age, Karnofsky performance score (KPS), tumor location, and tumor subtype, OS was predicted by EOR (hazard ratio [HR] = 0.972; 95% CI, 0.960 to 0.983; P < .001), log preoperative tumor volume (HR = 4.442; 95% CI, 1.601 to 12.320; P = .004), and postoperative tumor volume (HR = 1.010; 95% CI, 1.001 to 1.019; P = .03), progression-free survival was predicted by log preoperative tumor volume (HR = 2.711; 95% CI, 1.590 to 4.623; P <or= .001) and postoperative tumor volume (HR = 1.007; 95% CI, 1.001 to 1.014; P = .035), and malignant progression-free survival was predicted by EOR (HR = 0.983; 95% CI, 0.972 to 0.995; P = .005) and log preoperative tumor volume (HR = 3.826; 95% CI, 1.632 to 8.969; P = .002).

CONCLUSION

Improved outcome among adult patients with hemispheric LGG is predicted by greater EOR.

摘要

目的

低级别胶质瘤（LGG）切除范围（EOR）的预后作用是一个主要争议点。我们设计了一项回顾性研究来评估EOR对LGG长期预后的影响。

患者与方法

研究人群（N = 216）包括接受半球LGG初次切除的成年人。基于液体衰减反转恢复（FLAIR）成像进行感兴趣区分析以测量肿瘤体积。

结果

术前和术后肿瘤体积中位数以及EOR分别为36.6 cm³（范围，0.7至246.1 cm³）、3.7 cm³（范围，0至197.8 cm³）和88.0%（范围，5%至100%）。无手术死亡病例。36例患者（17%）出现新的术后神经功能缺损；然而，除4例患者外其余均完全恢复。有34例死亡（16%；中位随访时间，4.4年）。分别在95例（44%）和44例（20%）病例中发现疾病进展和恶性进展。EOR至少为90%的患者5年和8年总生存率（OS）分别为97%和91%，而EOR低于90%的患者5年和8年OS分别为76%和60%。在对年龄、卡诺夫斯基性能评分（KPS）、肿瘤位置和肿瘤亚型的每项肿瘤负荷指标进行校正后，OS由EOR（风险比[HR]=0.972；95%可信区间，0.960至0.983；P<.001）、术前肿瘤体积对数（HR = 4.442；95%可信区间，1.601至12.320；P = 0.004）和术后肿瘤体积（HR = 1.010；95%可信区间，1.001至1.019；P = 0.03）预测，无进展生存期由术前肿瘤体积对数（HR = 2.711；95%可信区间，1.590至4.623；P≤0.001）和术后肿瘤体积（HR = 1.007；95%可信区间，1.001至1.014；P = 0.035）预测，无恶性进展生存期由EOR（HR = 0.983；95%可信区间，0.972至0.995；P = 0.005）和术前肿瘤体积对数（HR = 3.826；95%可信区间，1.632至8.969；P = 0.002）预测。