Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
J Neurooncol. 2009 Dec;95(3):301-305. doi: 10.1007/s11060-009-9946-9. Epub 2009 Jun 26.
Extended survival of 3 or more years is rare in patients with glioblastoma (GBM) but is becoming more common. Clinical outcome has not been well studied. We reviewed GBM patients at Memorial Sloan-Kettering Cancer Center between 2001 and 2003 who were seen for two or more visits. Patient characteristics and long-term clinical outcomes were reviewed for patients who had survived 3 or more years following diagnosis. Thirty-nine (11%) of 352 GBM patients were identified as long-term survivors. Median survival was 9.15 years (range: 3-18 years). Median age was 47 years (range: 16-69); 13% were 65 years or older. Median KPS was 90 (range: 50-100). One long-term survivor underwent biopsy alone; 19 patients each had either complete or subtotal resection. All received focal radiotherapy (RT) with a median dose of 5940 cGy; 18% received concurrent temozolomide. Adjuvant chemotherapy was administered to 35 (90%). Twelve patients (31%) remained in continuous remission. Twenty-seven had tumor progression a median of 29.2 months after diagnosis (range: 1.2-167 months); 18 had multiple relapses. Median KPS at last follow-up was 70 (range: 40-100); 85% of long-term survivors had at least one significant neurologic deficit. Eleven (28%) had clinically significant RT-induced leukoencephalopathy, 9 (23%) developed RT necrosis and 9 (23%) treatment-related strokes. Treatment-related complications occurred a median of 2.7 years from diagnosis (range: 0.9-11.5 years). Long-term survivors remain rare, but are found across all age groups despite multiple recurrences; clinically significant delayed complications of treatment are common.
在胶质母细胞瘤（GBM）患者中，生存 3 年或以上的情况很少见，但这种情况变得越来越常见。临床结果尚未得到很好的研究。我们回顾了 2001 年至 2003 年期间在 Memorial Sloan-Kettering 癌症中心就诊的 2 次或以上就诊的 GBM 患者。对诊断后生存 3 年或以上的患者进行了患者特征和长期临床结果的回顾。在 352 名 GBM 患者中，有 39 名（11%）被确定为长期幸存者。中位生存时间为 9.15 年（范围：3-18 年）。中位年龄为 47 岁（范围：16-69 岁）；13%的患者年龄在 65 岁或以上。中位 KPS 为 90（范围：50-100）。1 名长期幸存者仅接受活检；19 名患者分别接受了完全或次全切除术。所有患者均接受了局灶性放疗（RT），中位剂量为 5940 cGy；18%的患者接受了替莫唑胺同步治疗。35 名患者（90%）接受了辅助化疗。12 名患者（31%）持续缓解。27 名患者在诊断后中位时间 29.2 个月（范围：1.2-167 个月）出现肿瘤进展；18 名患者出现多次复发。最后一次随访时的中位 KPS 为 70（范围：40-100）；85%的长期幸存者至少有 1 项严重的神经功能缺损。11 名患者（28%）出现有临床意义的放射性脑白质病，9 名患者（23%）发生放射性坏死，9 名患者（23%）发生与治疗相关的卒中。治疗相关并发症发生于诊断后中位时间 2.7 年（范围：0.9-11.5 年）。尽管多次复发，但长期幸存者在所有年龄组中仍然罕见；治疗相关的迟发性并发症很常见。
