Divisions of Neurological Surgery and.
J Neurosurg. 2014 Feb;120(2):309-14. doi: 10.3171/2013.10.JNS13368. Epub 2013 Dec 6.
Recent evidence suggests that a greater extent of resection (EOR) extends malignant progression-free survival among patients with low-grade gliomas (LGGs). These studies, however, rely on the combined analysis of oligodendrogliomas, astrocytomas, and mixed oligoastrocytomas-3 histological subtypes with distinct genetic and molecular compositions. To assess the value of EOR in a homogeneous LGG patient population and delineate its impact on LGG transformation, the authors examined its effect on newly diagnosed supratentorial oligodendrogliomas.
The authors identified 93 newly diagnosed adult patients with WHO Grade II oligodendrogliomas treated with microsurgical resection at Barrow Neurological Institute. Clinical, laboratory, and radiographic data were collected retrospectively, including 1p/19q codeletion status and volumetric analysis based on T2-weighted MRI.
The median preoperative and postoperative tumor volumes and EOR were 29.0 cm(3) (range 1.3-222.7 cm(3)), 5.2 cm(3) (range 0-156.1 cm(3)), and 85% (range 6%-100%), respectively. Median follow-up was 75.4 months, and there were 14 deaths (15%). Progression and malignant progression were identified in 31 (33%) and 20 (22%) cases, respectively. A greater EOR was associated with longer overall survival (p = 0.005) and progression-free survival (p = 0.004); however, a greater EOR did not prolong the interval to malignant progression, even when controlling for 1p/19q codeletion.
A greater EOR is associated with an improved survival profile for patients with WHO Grade II oligodendrogliomas. However, for this particular LGG patient population, the interval to tumor transformation is not influenced by cytoreduction. These data raise the possibility that the capacity for microsurgical resection to modulate malignant progression is mediated through biological mechanisms specific to nonoligodendroglioma LGG histologies.
最近的证据表明，在低级别胶质瘤（LGG）患者中，更大程度的切除（EOR）可延长恶性无进展生存期。然而，这些研究依赖于少突胶质细胞瘤、星形细胞瘤和混合性少突星形细胞瘤-3 种具有不同遗传和分子组成的组织学亚型的联合分析。为了评估 EOR 在同质 LGG 患者人群中的价值并描绘其对 LGG 转化的影响，作者研究了其对新诊断的幕上少突胶质细胞瘤的影响。
作者在巴罗神经研究所识别了 93 名新诊断的成人 WHO 二级少突胶质细胞瘤患者，他们接受了显微镜下切除术治疗。回顾性收集临床、实验室和影像学数据，包括 1p/19q 缺失状态和基于 T2 加权 MRI 的体积分析。
中位术前和术后肿瘤体积和 EOR 分别为 29.0cm3（范围 1.3-222.7cm3）、5.2cm3（范围 0-156.1cm3）和 85%（范围 6%-100%）。中位随访时间为 75.4 个月，有 14 例死亡（15%）。分别有 31 例（33%）和 20 例（22%）患者发生进展和恶性进展。较大的 EOR 与更长的总生存期（p=0.005）和无进展生存期（p=0.004）相关；然而，即使控制 1p/19q 缺失，较大的 EOR 也不会延长肿瘤转化的间隔时间。
更大的 EOR 与 WHO 二级少突胶质细胞瘤患者的生存状况改善相关。然而，对于这一特定的 LGG 患者人群，肿瘤转化的间隔时间不受细胞减少的影响。这些数据提出了一种可能性，即通过特定于非少突胶质细胞瘤 LGG 组织学的生物学机制，显微镜下切除术切除能力来调节恶性进展。
