Surgical and Molecular Neurooncology Unit, National Institute of Neurological Disorders and Stroke,Neuro-oncology Branch, National Cancer Institute and National Institute of Arthritis and Musculoskeletal andSkin Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
J Clin Oncol. 2010 Aug 20;28(24):3838-43. doi: 10.1200/JCO.2010.30.0582. Epub 2010 Jul 19.
Despite initial treatment with surgical resection, radiotherapy, and chemotherapy, glioblastoma multiforme (GBM) virtually always recurs. Surgery is sometimes recommended to treat recurrence. In this study, we sought to devise a preoperative scale that predicts survival after surgery for recurrent glioblastoma multiforme.
The preoperative clinical and radiographic data of 34 patients who underwent re-operation of recurrent GBM tumors were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression modeling. The factors associated with decreased postoperative survival (P < .05) were used to devise a prognostic scale which was validated with a separate cohort of 109 patients.
The factors associated with poor postoperative survival were: tumor involvement of prespecified eloquent/critical brain regions (P = .021), Karnofsky performance status (KPS) < or = 80 (P = .030), and tumor volume > or = 50 cm(3) (P = .048). An additive scale (range, 0 to 3 points) comprised of these three variables distinguishes patients with good (0 points), intermediate (1 to 2 points), and poor (3 points) postoperative survival (median survival, 10.8, 4.5, and 1.0 months, respectively; P < .001). The scale identified three statistically distinct groups within the validation cohort as well (median survival, 9.2, 6.3, and 1.9 months, respectively; P < .001).
We devised and validated a preoperative scale that identifies patients likely to have poor, intermediate, and good relative outcomes after surgical resection of a recurrent GBM tumor. Application of this simple scale may be useful in counseling patients regarding their treatment options and in designing clinical trials.
尽管胶质母细胞瘤（GBM）最初采用手术切除、放疗和化疗进行治疗，但实际上几乎总会复发。有时会建议手术来治疗复发。在这项研究中，我们试图设计一种术前量表，以预测复发性多形性胶质母细胞瘤手术后的生存情况。
对 34 名接受复发性 GBM 肿瘤再手术的患者的术前临床和影像学资料进行了分析，采用 Kaplan-Meier 生存分析和 Cox 比例风险回归模型。与术后生存时间缩短（P<.05）相关的因素被用于设计一个预后量表，并在另一组 109 名患者中进行验证。
与术后生存不良相关的因素包括：肿瘤累及预定的重要/关键脑区（P=.021）、卡氏功能状态评分（KPS）≤80（P=.030）和肿瘤体积≥50cm³（P=.048）。由这三个变量组成的加性量表（范围为 0 至 3 分）区分了术后生存良好（0 分）、中等（1 至 2 分）和不良（3 分）的患者（中位生存时间分别为 10.8、4.5 和 1.0 个月，P<.001）。该量表在验证队列中也能将患者分为三个具有统计学差异的组（中位生存时间分别为 9.2、6.3 和 1.9 个月，P<.001）。
我们设计并验证了一种术前量表，可识别出接受复发性 GBM 肿瘤切除手术后生存情况可能较差、中等和较好的患者。应用该简单量表有助于为患者提供治疗选择咨询，并设计临床试验。
