Napolitano M, Vaz G, Lawson T M, Docquier M-A, van Maanen A, Duprez T, Raftopoulos C
Department of neurosurgery, university hospital Saint-Luc, Université Catholique de Louvain (UCL), avenue Hippocrate, 10, 1200 Brussels, Belgium.
Department of anesthesiology, university hospital Saint-Luc, Université Catholique de Louvain (UCL), avenue Hippocrate, 10, 1200 Brussels, Belgium.
Neurochirurgie. 2014 Aug;60(4):143-50. doi: 10.1016/j.neuchi.2014.03.010. Epub 2014 Jun 26.
Gross total or near total resection (GTR/NTR; resection ≥95%) of glioblastoma (GBM) seems correlated with a longer survival. Intraoperative MRI (ioMRI) is one method to evaluate the extent of resection (EOR) in order to improve it during the same anesthesia. We compared GBM resections using a 3.0T ioMRI and then without considering the EOR, safety, survival and discussed the indications for using this expensive modality.
Between March 2006 and November 2011, 56 GBM resections were performed using an ioMRI, and 38 without (control group). The only criterion in order to have access to the ioMRI was its availability. We compared the variables EOR, Karnofsky Performance Scale scores and survival in both groups.
In the ioMRI group, 15 patients (26.8%) underwent an immediate second resection increasing the GTR rate of 10.7% and the GTR/NTR rate of 8.9%. There was a significant difference between the use of an ioMRI and the control group in reaching a larger EOR (P=0.049, Fisher's exact test). The effect of using the ioMRI or not on the overall survival, with EOR as covariate, was not significant (P=0.147, Likelihood ratio test). However, the EOR alone had a significant effect on survival (P=0.049, Wald test), with a shorter survival for the patients with a partial resection (PR) than a GTR/NTR (Hazard ratio=1.6, 95% CI HR: 1.00-2.69), with a median overall survival of 15.26 months (95% CI: 12.34-19.08) for the GTR/NTR subgroup versus 10.26 months (95% CI: 6.64-15.82) for the PR subgroup. Multivariate regression analysis also identified age, sex and adjuvant chemotherapy as factors significantly associated with overall survival.
A 3.0T ioMRI improved the quality of resection by 17.8% and increased the GTR/NTR rate by 8.9% up to 73.2% without additional morbidity. A GTR/NTR improves survival duration by about 50%. Thus, it remains reasonable to increase the EOR to reach GTR/NTR using an intraoperative control. However, ioMRI should be limited to the cases for which a GTR/NTR seems preoperatively possible.
胶质母细胞瘤（GBM）的全切除或近全切除（GTR/NTR；切除率≥95%）似乎与更长的生存期相关。术中磁共振成像（ioMRI）是一种评估切除范围（EOR）的方法，以便在同一麻醉过程中改善切除效果。我们比较了使用3.0T ioMRI进行的GBM切除术，然后在不考虑EOR、安全性、生存期的情况下，讨论了使用这种昂贵方式的适应症。
2006年3月至2011年11月期间，使用ioMRI进行了56例GBM切除术，38例未使用ioMRI（对照组）。能够使用ioMRI的唯一标准是其可用性。我们比较了两组的EOR、卡诺夫斯基功能状态评分和生存期变量。
在ioMRI组中，15例患者（26.8%）立即接受了二次切除，GTR率提高了10.7%，GTR/NTR率提高了8.9%。在达到更大的EOR方面，使用ioMRI与对照组之间存在显著差异（P=0.049，Fisher精确检验）。以EOR作为协变量，使用或不使用ioMRI对总生存期的影响不显著（P=0.147，似然比检验）。然而，单独的EOR对生存期有显著影响（P=0.049，Wald检验），部分切除（PR）患者的生存期比GTR/NTR患者短（风险比=1.6，95%CI HR：1.00-2.69），GTR/NTR亚组的中位总生存期为15.26个月（95%CI：12.34-19.08），而PR亚组为10.26个月（95%CI：6.64-15.82）。多变量回归分析还确定年龄、性别和辅助化疗是与总生存期显著相关的因素。
3.0T ioMRI将切除质量提高了17.8%，GTR/NTR率提高了8.9%，最高可达73.2%，且无额外的发病率。GTR/NTR可将生存期延长约50%。因此，通过术中控制提高EOR以达到GTR/NTR仍然是合理的。然而，ioMRI应仅限于术前似乎有可能实现GTR/NTR的病例。
