Kole Adam J, Park Henry S, Yeboa Debra N, Rutter Charles E, Corso Christopher D, Aneja Sanjay, Lester-Coll Nataniel H, Mancini Brandon R, Knisely Jonathan P, Yu James B
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Department of Radiation Medicine, Northwell Health System and Hofstra Northwell School of Medicine, Lake Success, New York.
Cancer. 2016 Aug 1;122(15):2364-70. doi: 10.1002/cncr.30063. Epub 2016 May 12.
Combined temozolomide and radiotherapy (RT) is the standard postoperative therapy for glioblastoma multiforme (GBM). However, the clearest benefit of concurrent chemoradiotherapy (CRT) observed in clinical trials has been among patients who undergo surgical resection. Whether the improved survival with CRT extends to patients who undergo "biopsy only" is less certain. The authors compared overall survival (OS) in a national cohort of patients with GBM who underwent biopsy and received either RT alone or CRT during the temozolomide era.
The US National Cancer Data Base was used to identify patients with histologically confirmed, biopsy-only GBM who received either RT alone or CRT from 2006 through 2011. Demographic and clinicopathologic predictors of treatment were analyzed using the chi-square test, the t test, and multivariable logistic regression. OS was evaluated using the log-rank test, multivariable Cox proportional hazard regression, and propensity score-matched analysis.
In total, 1479 patients with biopsy-only GBM were included, among whom 154 (10.4%) received RT alone and 1325 (89.6%) received CRT. The median age at diagnosis was 61 years. CRT was associated with a significant OS benefit compared with RT alone (median, 9.2 vs 5.6 months; hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.54-0.76; P < .001). CRT was independently associated with improved OS compared with RT alone on multivariable analysis (HR, 0.71; 95% CI, 0.60-0.85; P < .001). A significant OS benefit for CRT persisted in a propensity score-matched analysis (HR, 0.72; 95% CI, 0.56-0.93; P = .009).
The current data suggest that CRT significantly improves OS in patients with GBM who undergo biopsy only compared with RT alone and should remain the standard of care for patients who can tolerate therapy. Cancer 2016;122:2364-2370. © 2016 American Cancer Society.
替莫唑胺与放疗（RT）联合是多形性胶质母细胞瘤（GBM）标准的术后治疗方案。然而，在临床试验中观察到的同步放化疗（CRT）最显著的益处存在于接受手术切除的患者中。CRT带来的生存期改善是否能扩展到仅接受“活检”的患者尚不确定。作者比较了替莫唑胺时代全国范围内仅接受活检且单独接受放疗或CRT的GBM患者队列的总生存期（OS）。
利用美国国家癌症数据库识别2006年至2011年间组织学确诊、仅接受活检的GBM患者，这些患者单独接受放疗或CRT。使用卡方检验、t检验和多变量逻辑回归分析治疗的人口统计学和临床病理预测因素。使用对数秩检验、多变量Cox比例风险回归和倾向评分匹配分析评估OS。
总共纳入了1479例仅接受活检的GBM患者，其中154例（10.4%）单独接受放疗，1325例（89.6%）接受CRT。诊断时的中位年龄为61岁。与单独放疗相比，CRT具有显著的OS益处（中位生存期分别为9.2个月和5.6个月；风险比[HR]为0.64；95%置信区间[CI]为0.54 - 0.76；P <.001）。在多变量分析中，与单独放疗相比，CRT与改善的OS独立相关（HR为0.71；95%CI为0.60 - 0.85；P <.001）。在倾向评分匹配分析中，CRT的显著OS益处仍然存在（HR为0.72；95%CI为0.56 - 0.93；P =.009）。
目前的数据表明，与单独放疗相比，CRT能显著改善仅接受活检的GBM患者的OS，对于能够耐受治疗的患者应仍然是标准治疗方案。《癌症》2016年；122:2364 - 2370。©2016美国癌症协会。
