Narayana Ashwatha, Perretta Donato, Kunnakkat Saroj, Gruber Deborah, Golfinos John, Parker Erik, Medabalmi Praveen, Zagzag David, Pat Eagan R N, Gruber Michael
Department of Radiation Oncology and Neurosurgery, New York University Langone Medical Center, New York, NY 10016, USA.
J Cancer Res Ther. 2011 Jul-Sep;7(3):331-5. doi: 10.4103/0973-1482.87039.
The role of invasion as a prognostic factor in high-grade gliomas (HGG) remains controversial. An apparent increase in invasiveness following anti-angiogenic therapy makes this question clinically relevant. The goal of this study is to assess survival differences in patients with newly diagnosed HGG who present with diffuse invasive disease compared to those who did not, but went on to develop diffuse invasive disease following bevacizumab therapy.
Twenty-three patients presented as newly diagnosed diffuse invasive HGG. All patients underwent surgical resection with radiation therapy and temozolomide for one year. Progression-free survival (PFS) and overall survival (OS) were compared to a control of 58 patients with focal high-grade glioma who received similar therapy, but that included bevacizumab at 10 mg/kg given every two weeks.
The patient characteristics were similar in each group. The median PFS and OS for invasive HGG patients were 6 and 13 months and for the focal HGG patients, 11 and 24 months, respectively (P=0.092 and P=0.071). In the subgroup of invasive HGG that showed significant angiogenesis, the median PFS and OS were 3 and 9 months, respectively. 56% of the focal HGG patients recurred as diffuse invasive relapse. For patients with focal HGG who recurred as invasive disease, the median PFS and OS were 9 and 21 months respectively.
Presence of diffuse invasive disease not accompanied by angiogenesis either prior to therapy or subsequent to anti-angiogenic therapy does not seem to have prognostic significance. However, invasion accompanied by angiogenesis in newly diagnosed HGG may confer a poor prognosis.
侵袭作为高级别胶质瘤（HGG）预后因素的作用仍存在争议。抗血管生成治疗后侵袭性明显增加使这个问题具有临床相关性。本研究的目的是评估新诊断的伴有弥漫性侵袭性疾病的HGG患者与那些虽无弥漫性侵袭性疾病但在贝伐单抗治疗后发展为弥漫性侵袭性疾病的患者之间的生存差异。
23例患者初诊为弥漫性侵袭性HGG。所有患者均接受手术切除，并接受放疗和替莫唑胺治疗一年。将无进展生存期（PFS）和总生存期（OS）与58例局灶性高级别胶质瘤患者的对照组进行比较，这些患者接受了类似的治疗，但包括每两周给予10mg/kg的贝伐单抗。
每组患者的特征相似。侵袭性HGG患者的中位PFS和OS分别为6个月和13个月，局灶性HGG患者分别为11个月和24个月（P = 0.092和P = 0.071）。在显示显著血管生成的侵袭性HGG亚组中，中位PFS和OS分别为3个月和9个月。56%的局灶性HGG患者复发为弥漫性侵袭性复发。对于复发为侵袭性疾病的局灶性HGG患者，中位PFS和OS分别为9个月和21个月。
在治疗前或抗血管生成治疗后，存在不伴有血管生成的弥漫性侵袭性疾病似乎没有预后意义。然而，新诊断的HGG中伴有血管生成的侵袭可能预示预后不良。
