Hrabalek Lumir, Kalita Ondrej, Vaverka Miroslav, Zlevorova Miloslava, Ehrmann Jiri, Cechakova Eva, Adamus Milan, Novak Vlastimil, Langova Katerina
Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015 Mar;159(1):150-5. doi: 10.5507/bp.2013.052. Epub 2013 Jul 29.
The aim of this study was to compare resection and biopsy of glioblastoma (GBM) in eloquent brain areas (EBA).
This was a prospective evaluation of 38 patients with GBM in EBA. 22 were treated by surgical resection and 16 by biopsy. Preoperative KPS, neurological status and size of lesion on MRI were assessed. One week and three months postoperatively KPS, neurological status and Performance Status (PS) WHO were evaluated. Extent of resection (EOR) and overall survival (OS) were described. Overall mean age of the patients was 64.3 years, the mean lesion size in the resection group was 47.7 mm and in the biopsy group 51.0 mm.
Worsening or development of permanent neurological deficits 3 months after surgery were significantly lower in the resection group (23%), than the biopsy group (94%). In the resection group the median pre and postoperative KPS three months after surgery was 80.0. In the biopsy group the median pre and postoperative KPS was 68.1 one week after the procedure. In the resection group, 3 months after surgery, the median PS was 1, in the biopsy group one week after surgery the median PS was 2. The difference was statistically insignificant. The mean OS after resection was 12.2 months, and after biopsy 3.5 months. The difference was highly statistically significant. The mean EOR was 90%.
This is the first prospective study, to our knowledge, that compares the results of resection and biopsy of primary GBM in EBA. For patients in good clinical condition with tumors in or near EBA, recommended is as radical resection of GBM as possible.
本研究旨在比较在脑功能区（EBA）的胶质母细胞瘤（GBM）的切除术和活检术。
这是一项对38例EBA区GBM患者的前瞻性评估。22例接受手术切除，16例接受活检。评估术前的KPS评分、神经状态和MRI上的病变大小。术后1周和3个月评估KPS评分、神经状态和世界卫生组织表现状态（PS）。描述切除范围（EOR）和总生存期（OS）。患者的总体平均年龄为64.3岁，切除组的平均病变大小为47.7mm，活检组为51.0mm。
切除组术后3个月永久性神经功能缺损的恶化或发生情况（23%）明显低于活检组（94%）。切除组术后3个月术前和术后KPS评分的中位数为80.0。活检组术后1周术前和术后KPS评分的中位数为68.1。切除组术后3个月，PS评分中位数为1，活检组术后1周PS评分中位数为2。差异无统计学意义。切除术后的平均OS为12.2个月，活检术后为3.5个月。差异具有高度统计学意义。平均EOR为90%。
据我们所知，这是第一项比较EBA区原发性GBM切除术和活检术结果的前瞻性研究。对于临床状况良好、肿瘤位于EBA区或其附近的患者，建议尽可能彻底切除GBM。
