Padwal Jennifer A, Dong Xuezhi, Hirshman Brian R, Hoi-Sang U, Carter Bob S, Chen Clark C
School of Medicine, University of California, San Diego, La Jolla, California, USA.
School of Medicine, University of California, San Diego, La Jolla, California, USA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA.
World Neurosurg. 2016 Jun;90:186-193. doi: 10.1016/j.wneu.2016.02.078. Epub 2016 Feb 24.
Because of their relative rarity, anaplastic astrocytomas (AAs) often are grouped with glioblastomas in clinical treatment paradigms. There are reasons, however, to expect that the therapeutic response of AAs may differ from those of glioblastoma. Here, we examined the clinical benefit of gross total resection (GTR) in AA relative to glioblastoma patients.
Using the Surveillance, Epidemiology and End Results database, we identified 2755 patients with AA and patients with 21,962 glioblastoma between 1999 and 2010. Surgical resection was defined as GTR, subtotal resection (STR), biopsy only, or no resection. Kaplan-Meier curves and multivariate Cox regression were used to assess the association between GTR and survival.
The hazard of dying from the AA was reduced in GTR patients by 40% relative to STR patients. This reduction is 59% greater than that observed in glioblastoma where GTR was associated only with a 24% reduction relative to STR (P < 0.0001). The median survival for patients with AA who underwent GTR and subtotal resection were 64 and 24 months, respectively. For glioblastoma patients, the corresponding numbers for median survival were 13 and 9 months, respectively. The survival benefit of GTR in patients with AA was particularly notable in patient age < 50, where the median survival was not reached during the study period.
The Surveillance, Epidemiology and End Results data suggest that survival benefit associated with GTR was greater for patients with AA relative to glioblastoma patients, particularly for patients < age 50.
由于间变性星形细胞瘤（AA）相对罕见，在临床治疗模式中，它们常与胶质母细胞瘤归为一类。然而，有理由预期AA的治疗反应可能与胶质母细胞瘤不同。在此，我们研究了相对于胶质母细胞瘤患者，AA患者行大体全切除（GTR）的临床获益。
利用监测、流行病学和最终结果数据库，我们确定了1999年至2010年间2755例AA患者和21962例胶质母细胞瘤患者。手术切除定义为GTR、次全切除（STR）、仅活检或未切除。采用Kaplan-Meier曲线和多变量Cox回归评估GTR与生存之间的关联。
与STR患者相比，GTR患者因AA死亡的风险降低了40%。这一降低幅度比在胶质母细胞瘤中观察到的高59%，在胶质母细胞瘤中，GTR相对于STR仅使死亡风险降低了24%（P<0.0001）。接受GTR和次全切除的AA患者的中位生存期分别为64个月和24个月。对于胶质母细胞瘤患者，相应的中位生存期数字分别为13个月和9个月。GTR对AA患者的生存获益在年龄<50岁的患者中尤为显著，在研究期间其中位生存期未达到。
监测、流行病学和最终结果数据表明，相对于胶质母细胞瘤患者，GTR对AA患者的生存获益更大，尤其是对于年龄<50岁的患者。
