Ramakrishna Rohan, Hebb Adam, Barber Jason, Rostomily Robert, Silbergeld Daniel
*Weill Cornell Medical College, New York Presbyterian Hospital, Department of Neurological Surgery, New York, New York; ‡Colorado Neurological Institute, Englewood, Colorado; §University of Washington, School of Medicine, Department of Neurological Surgery, Seattle, Washington.
Neurosurgery. 2015 Aug;77(2):175-84; discussion 184. doi: 10.1227/NEU.0000000000000753.
Low-grade gliomas (LGGs) comprise a diverse set of intrinsic brain tumors that correlate strongly with survival. Data on the effect of reoperation are sparse.
To evaluate the effect of reoperation on patients with LGG.
Fifty-two consecutive patients with reoperated LGGs treated at the University of Washington between 1986 and 2004 were identified and evaluated in a retrospective analysis.
The average overall survival (OS) for this cohort was 12.95 ± 0.96 years. The overall 10-year survival rate was 57%. The absence of any residual tumor at either the first or second operation was associated with significantly increased OS. Negative prognostic variables for OS included the use of upfront radiation and pathology at recurrence. The average overall progression-free survival to the first recurrence (PFS1) was 6.23 ± 0.51 years. Positive prognostic factors for improved PFS1 included the use of upfront radiation therapy. Variables not associated with differences in PFS1 included the use of upfront chemotherapy, enhancement, pathology, extent of resection, the presence of residual tumor, and Karnofsky Performance Scale score <80. The average overall progression-free survival to the second recurrence was 2.73 ± 0.39 years. Pathology at recurrence was associated with significant differences in progression-free survival to the second recurrence, as was extent of resection at time of first recurrence, and Karnofsky Performance Scale score <80.
This is among the largest studies to assess variables associated with outcome in patients with reoperated LGG. Reresection appears to provide significant benefit, and extent of resection remains the strongest predictor of OS.
低级别胶质瘤（LGGs）是一组多样的原发性脑肿瘤，与生存率密切相关。关于再次手术效果的数据稀少。
评估再次手术对LGG患者的影响。
对1986年至2004年在华盛顿大学接受再次手术治疗的52例连续LGG患者进行回顾性分析和评估。
该队列的平均总生存期（OS）为12.95±0.96年。10年总生存率为57%。首次或第二次手术时无任何残留肿瘤与OS显著增加相关。OS的负面预后变量包括复发时采用 upfront 放疗和病理情况。至首次复发的平均总无进展生存期（PFS1）为6.23±0.51年。改善PFS1的阳性预后因素包括采用 upfront 放疗。与PFS1差异无关的变量包括采用 upfront 化疗、强化、病理、切除范围、残留肿瘤的存在以及卡氏功能状态评分<80。至第二次复发的平均总无进展生存期为2.73±0.39年。复发时的病理情况与至第二次复发的无进展生存期显著差异相关，首次复发时的切除范围以及卡氏功能状态评分<80也与之相关。
这是评估再次手术的LGG患者结局相关变量的最大规模研究之一。再次切除似乎能带来显著益处，切除范围仍是OS的最强预测因素。
