Department of Neurosurgery, Clínica Universidad de Navarra, Pamplona, Spain.
Neurosurgery. 2013 Jun;72(6):915-20; discussion 920-1. doi: 10.1227/NEU.0b013e31828c3974.
There is evidence in the literature supporting that fluorescent tissue signal in fluorescence-guided surgery extends farther than tissue highlighted in gadolinium in T1 sequence magnetic resonance imaging (MRI), which is the standard to quantify the extent of resection.
To study whether the presence of residual fluorescent tissue after surgery carries a different prognosis for glioblastoma (GBM) cases with complete resection confirmed by MRI.
A retrospective review in our center found 118 consecutive patients with high-grade gliomas operated on with the use of fluorescence-guided surgery with 5-aminolevulinic acid. Within that series, the 52 patients with newly diagnosed GBM and complete resection of enhancing tumor (CRET) in early MRI were selected for analysis. We studied the influence of residual fluorescence in the surgical field on overall survival and neurological complication rate. Multivariate analysis included potential relevant factors: age, Karnofsky Performance Scale, O-methylguanine methyltransferase methylation promoter status, tumor eloquent location, preoperative tumor volume, and adjuvant therapy.
The median overall survival was 27.0 months (confidence interval = 22.4-31.6) in patients with nonresidual fluorescence (n = 25) and 17.5 months (confidence interval = 12.5-22.5) for the group with residual fluorescence (n = 27) (P = .015). The influence of residual fluorescence was maintained in the multivariate analysis with all covariables, hazard ratio = 2.5 (P = .041). The neurological complication rate was 18.5% in patients with nonresidual fluorescence and 8% for the group with residual fluorescence (P = .267).
GBM patients with CRET in early MRI and no fluorescent residual tissue had longer overall survival than patients with CRET and residual fluorescent tissue.
文献中有证据表明，荧光组织信号在荧光引导手术中的延伸范围超过钆增强 T1 序列磁共振成像（MRI）中突出的组织，后者是量化切除范围的标准。
研究手术后残留荧光组织是否对 MRI 证实完全切除的胶质母细胞瘤（GBM）病例的预后产生不同影响。
我们中心的一项回顾性研究发现，118 例连续接受 5-氨基乙酰丙酸荧光引导手术的高级别胶质瘤患者。在该系列中，选择了 52 例新诊断的 GBM 患者和早期 MRI 中增强肿瘤的完全切除术（CRET）患者进行分析。我们研究了手术野中残留荧光对总生存期和神经并发症发生率的影响。多变量分析包括潜在的相关因素：年龄、卡诺夫斯基表现量表、O-甲基鸟嘌呤甲基转移酶甲基化启动子状态、肿瘤功能区位置、术前肿瘤体积和辅助治疗。
无残留荧光的患者中位总生存期为 27.0 个月（置信区间为 22.4-31.6），有残留荧光的患者为 17.5 个月（置信区间为 12.5-22.5）（P =.015）。在多变量分析中，所有协变量的残留荧光影响均保持不变，风险比为 2.5（P =.041）。无残留荧光的患者神经并发症发生率为 18.5%，有残留荧光的患者为 8%（P =.267）。
MRI 早期出现 CRET 且无荧光残留组织的 GBM 患者的总生存期长于出现 CRET 且有荧光残留组织的患者。
