老年高级别胶质瘤患者活检与部分切除及全切的比较：一项系统评价和荟萃分析。

Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis.

作者信息

Almenawer Saleh A, Badhiwala Jetan H, Alhazzani Waleed, Greenspoon Jeffrey, Farrokhyar Forough, Yarascavitch Blake, Algird Almunder, Kachur Edward, Cenic Aleksa, Sharieff Waseem, Klurfan Paula, Gunnarsson Thorsteinn, Ajani Olufemi, Reddy Kesava, Singh Sheila K, Murty Naresh K

机构信息

Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada (S.A.A., A.A., E.K., A.C., P.K., T.G., O.A., K.R., S.K.S., N.K.M.); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (S.A.A., W.A., F.F.); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (W.A.); Department of Oncology, McMaster University, Hamilton, Ontario, Canada (J.G.); Stem Cell and Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada (S.K.S.); Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada (J.H.B.); Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada (W.S.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (B.Y.).

出版信息

Neuro Oncol. 2015 Jun;17(6):868-81. doi: 10.1093/neuonc/nou349. Epub 2015 Jan 3.

DOI:10.1093/neuonc/nou349

PMID:25556920

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4483123/

Abstract

BACKGROUND

Optimal extent of surgical resection (EOR) of high-grade gliomas (HGGs) remains uncertain in the elderly given the unclear benefits and potentially higher rates of mortality and morbidity associated with more extensive degrees of resection.

METHODS

We undertook a meta-analysis according to a predefined protocol and systematically searched literature databases for reports about HGG EOR. Elderly patients (≥60 y) undergoing biopsy, subtotal resection (STR), and gross total resection (GTR) were compared for the outcome measures of overall survival (OS), postoperative karnofsky performance status (KPS), progression-free survival (PFS), mortality, and morbidity. Treatment effects as pooled estimates, mean differences (MDs), or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were determined using random effects modeling.

RESULTS

A total of 12 607 participants from 34 studies met eligibility criteria, including our current cohort of 211 patients. When comparing overall resection (of any extent) with biopsy, in favor of the resection group were OS (MD 3.88 mo, 95% CI: 2.14-5.62, P < .001), postoperative KPS (MD 10.4, 95% CI: 6.58-14.22, P < .001), PFS (MD 2.44 mo, 95% CI: 1.45-3.43, P < .001), mortality (RR = 0.27, 95% CI: 0.12-0.61, P = .002), and morbidity (RR = 0.82, 95% CI: 0.46-1.46, P = .514) . GTR was significantly superior to STR in terms of OS (MD 3.77 mo, 95% CI: 2.26-5.29, P < .001), postoperative KPS (MD 4.91, 95% CI: 0.91-8.92, P = .016), and PFS (MD 2.21 mo, 95% CI: 1.13-3.3, P < .001) with no difference in mortality (RR = 0.53, 95% CI: 0.05-5.71, P = .600) or morbidity (RR = 0.52, 95% CI: 0.18-1.49, P = .223).

CONCLUSIONS

Our findings suggest an upward improvement in survival time, functional recovery, and tumor recurrence rate associated with increasing extents of safe resection. These benefits did not result in higher rates of mortality or morbidity if considered in conjunction with known established safety measures when managing elderly patients harboring HGGs.

摘要

背景

鉴于获益不明确以及与更广泛切除程度相关的潜在更高死亡率和发病率，老年高级别胶质瘤（HGG）手术切除范围（EOR）的最佳程度仍不确定。

方法

我们根据预定义方案进行了一项荟萃分析，并系统检索文献数据库以获取有关HGG EOR的报告。比较了接受活检、次全切除（STR）和全切除（GTR）的老年患者（≥60岁）的总生存期（OS）、术后卡诺夫斯基功能状态（KPS）、无进展生存期（PFS）、死亡率和发病率等结局指标。使用随机效应模型确定作为汇总估计值、平均差（MDs）或风险比（RRs）以及相应95%置信区间（CIs）的治疗效果。

结果

来自34项研究的总共12607名参与者符合纳入标准，包括我们当前队列中的211名患者。当将任何程度的全切除与活检进行比较时，切除组在OS（MD 3.88个月，95%CI：2.14 - 5.62，P <.001）、术后KPS（MD 10.4，95%CI：6.58 - 14.22，P <.001）、PFS（MD 2.44个月，95%CI：1.45 - 3.43，P <.001）、死亡率（RR = 0.27，95%CI：0.12 - 0.61，P =.002）和发病率（RR = 0.82，95%CI：0.46 - 1.46，P =.514）方面更具优势。在OS（MD 3.77个月，95%CI：2.26 - 5.29，P <.001）、术后KPS（MD 4.91，95%CI：0.91 - 8.92，P =.016）和PFS（MD 2.21个月，95%CI：1.13 - 3.3，P <.001）方面，GTR显著优于STR，而在死亡率（RR = 0.53，95%CI：0.05 - 5.71，P =.600）或发病率（RR = 0.52，95%CI：0.18 - 1.49，P =.223）方面无差异。