Nitta Masayuki, Muragaki Yoshihiro, Maruyama Takashi, Ikuta Soko, Komori Takashi, Maebayashi Katsuya, Iseki Hiroshi, Tamura Manabu, Saito Taiichi, Okamoto Saori, Chernov Mikhail, Hayashi Motohiro, Okada Yoshikazu
Department of Neurosurgery;
Neurosurg Focus. 2015 Jan;38(1):E7. doi: 10.3171/2014.10.FOCUS14651.
OBJECT There is no standard therapeutic strategy for low-grade glioma (LGG). The authors hypothesized that adjuvant therapy might not be necessary for LGG cases in which total radiological resection was achieved. Accordingly, they established a treatment strategy based on the extent of resection (EOR) and the MIB-1 index: patients with a high EOR and low MIB-1 index were observed without postoperative treatment, whereas those with a low EOR and/or high MIB-1 index received radiotherapy (RT) and/or chemotherapy. In the present retrospective study, the authors reviewed clinical data on patients with primarily diagnosed LGGs who had been treated according to the above-mentioned strategy, and they validated the treatment policy. Given their results, they will establish a new treatment strategy for LGGs stratified by EOR, histological subtype, and molecular status. METHODS One hundred fifty-three patients with diagnosed LGG who had undergone resection or biopsy at Tokyo Women's Medical University between January 2000 and August 2010 were analyzed. The patients consisted of 84 men and 69 women, all with ages ≥ 15 years. A total of 146 patients underwent surgical removal of the tumor, and 7 patients underwent biopsy. RESULTS Postoperative RT and nitrosourea-based chemotherapy were administered in 48 and 35 patients, respectively. Extent of resection was significantly associated with both overall survival (OS; p = 0.0096) and progression-free survival (PFS; p = 0.0007) in patients with diffuse astrocytoma but not in those with oligodendroglial subtypes. Chemotherapy significantly prolonged PFS, especially in patients with oligodendroglial subtypes (p = 0.0009). Patients with a mutant IDH1 gene had significantly longer OS (p = 0.034). Multivariate analysis did not identify MIB-1 index or RT as prognostic factors, but it did identify chemotherapy as a prognostic factor for PFS and EOR as a prognostic factor for OS and PFS. CONCLUSIONS The findings demonstrated that EOR was significantly correlated with patient survival; thus, one should aim for maximum tumor resection. In addition, patients with a higher EOR can be safely observed without adjuvant therapy. For patients with partial resection, postoperative chemotherapy should be administered for those with oligodendroglial subtypes, and repeat resection should be considered for those with astrocytic tumors. More aggressive treatment with RT and chemotherapy may be required for patients with a poor prognosis, such as those with diffuse astrocytoma, 1p/19q nondeleted tumors, or IDH1 wild-type oligodendroglial tumors with partial resection.
对于低级别胶质瘤（LGG）尚无标准的治疗策略。作者推测，对于实现了影像学全切除的LGG病例，辅助治疗可能并非必要。因此，他们制定了一种基于切除范围（EOR）和MIB-1指数的治疗策略：EOR高且MIB-1指数低的患者术后不进行治疗，而EOR低和/或MIB-1指数高的患者接受放疗（RT）和/或化疗。在本回顾性研究中，作者回顾了根据上述策略治疗的初诊LGG患者的临床资料，并验证了该治疗策略。鉴于研究结果，他们将制定一种根据EOR、组织学亚型和分子状态分层的LGG新治疗策略。方法：分析了2000年1月至2010年8月在东京女子医科大学接受切除或活检的153例确诊LGG患者。患者包括84名男性和69名女性，年龄均≥15岁。共有146例患者接受了肿瘤手术切除，7例患者接受了活检。结果：分别有48例和35例患者接受了术后RT和基于亚硝基脲的化疗。在弥漫性星形细胞瘤患者中，切除范围与总生存期（OS；p = 0.0096）和无进展生存期（PFS；p = 0.0007）均显著相关，但在少突胶质细胞亚型患者中并非如此。化疗显著延长了PFS，尤其是在少突胶质细胞亚型患者中（p = 0.0009）。IDH1基因突变的患者OS显著更长（p = 0.034）。多因素分析未将MIB-1指数或RT确定为预后因素，但将化疗确定为PFS的预后因素，将EOR确定为OS和PFS的预后因素。结论：研究结果表明，EOR与患者生存期显著相关；因此，应争取最大程度地切除肿瘤。此外，EOR高的患者可以安全地观察而无需辅助治疗。对于部分切除的患者，少突胶质细胞亚型患者应给予术后化疗，星形细胞瘤患者应考虑再次切除。对于预后较差的患者，如弥漫性星形细胞瘤、1p/19q未缺失肿瘤或部分切除的IDH1野生型少突胶质细胞瘤患者，则可能需要更积极地进行RT和化疗。
