*College of Medicine Departments of ‡Pathology §Neurosurgery ∥Neurology ¶Radiation Oncology, Mayo Clinic, Rochester, MN †Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Am J Clin Oncol. 2013 Dec;36(6):612-9. doi: 10.1097/COC.0b013e31825d580a.
To determine prognostic factors and optimal timing of postoperative radiation therapy (RT) in adult low-grade gliomas.
Records from 554 adults diagnosed with nonpilocytic low-grade gliomas at Mayo Clinic between 1992 and 2011 were retrospectively reviewed.
Median follow-up was 5.2 years. Histology revealed astrocytoma in 22%, oligoastrocytoma in 34%, and oligodendroglioma in 45%. Initial surgery achieved gross total resection in 31%, radical subtotal resection in 10%, subtotal resection (STR) in 21%, and biopsy only in 39%. Median overall survival (OS) and progression-free survival (PFS) were 11.4 and 4.1 years, respectively. On multivariate analysis, factors associated with lower OS included astrocytomas and use of postoperative RT. Adverse prognostic factors for PFS on multivariate analysis included tumor size, astrocytomas, STR/biopsy only and not receiving RT. Patients undergoing gross total resection/radical subtotal resection had the best OS and PFS. Comparing survival with the log-rank test demonstrated no association between RT and PFS (P=0.24), but RT was associated with lower OS (P<0.0001). In patients undergoing STR/biopsy only, RT was associated with improved PFS (P<0.0001) but lower OS (P=0.03). Postoperative RT was associated with adverse prognostic factors including age > 40 years, deep tumors, size≥5 cm, astrocytomas and STR/biopsy only. Patients delaying RT until recurrence experienced 10-year OS (71%) similar to patients never needing RT (74%; P=0.34).
This study supports the association between aggressive surgical resection and better OS and PFS, and between postoperative RT and improved PFS in patients receiving STR/biopsy only. In addition, our findings suggest that delaying RT until progression is safe in patients who are eligible.
确定成人低级别胶质瘤术后放疗（RT）的预后因素和最佳时机。
回顾性分析 1992 年至 2011 年间在 Mayo 诊所诊断为非典型性低级别胶质瘤的 554 名成年人的病历。
中位随访时间为 5.2 年。组织学显示星形细胞瘤占 22%，少突星形细胞瘤占 34%，少突胶质细胞瘤占 45%。初次手术实现大体全切的占 31%，根治性次全切除占 10%，次全切除（STR）占 21%，仅活检占 39%。中位总生存期（OS）和无进展生存期（PFS）分别为 11.4 年和 4.1 年。多因素分析显示，OS 较低的相关因素包括星形细胞瘤和术后 RT 的应用。多因素分析中，PFS 的不良预后因素包括肿瘤大小、星形细胞瘤、STR/仅活检和未接受 RT。行大体全切/根治性次全切除的患者 OS 和 PFS 最佳。通过对数秩检验比较生存情况，发现 RT 与 PFS 之间无关联（P=0.24），但 RT 与 OS 降低相关（P<0.0001）。在仅行 STR/活检的患者中，RT 与 PFS 改善相关（P<0.0001），但 OS 降低（P=0.03）。术后 RT 与不良预后因素相关，包括年龄>40 岁、肿瘤位置深、肿瘤大小≥5cm、星形细胞瘤和 STR/仅活检。延迟 RT 至复发的患者 10 年 OS（71%）与从未需要 RT 的患者相似（74%；P=0.34）。
本研究支持积极的手术切除与更好的 OS 和 PFS 相关，以及在仅行 STR/活检的患者中，术后 RT 与改善 PFS 相关。此外，我们的发现表明，对于符合条件的患者，延迟至进展后再行 RT 是安全的。
