Saito Taiichi, Sugiyama Kazuhiko, Ikawa Fusao, Yamasaki Fumiyuki, Ishifuro Minoru, Takayasu Takeshi, Nosaka Ryo, Nishibuchi Ikuno, Muragaki Yoshihiro, Kawamata Takakazu, Kurisu Kaoru
Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan.
Department of Clinical Oncology and Neuro-oncology Program, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan.
World Neurosurg. 2017 Jan;97:21-26. doi: 10.1016/j.wneu.2016.09.072. Epub 2016 Sep 28.
The current standard treatment protocol for patients with newly diagnosed glioblastoma (GBM) includes surgery, radiotherapy, and concomitant and adjuvant temozolomide (TMZ). We hypothesized that the permeability surface area product (PS) from a perfusion computed tomography (PCT) study is associated with sensitivity to TMZ. The aim of this study was to determine whether PS values were correlated with prognosis of GBM patients who received the standard treatment protocol.
This study included 36 patients with GBM that were newly diagnosed between October 2005 and September 2014 and who underwent preoperative PCT study and the standard treatment protocol. We measured the maximum value of relative cerebral blood volume (rCBVmax) and the maximum PS value (PSmax). We statistically examined the relationship between PSmax and prognosis using survival analysis, including other clinicopathologic factors (age, Karnofsky performance status [KPS], extent of resection, O6-methylguanine-DNA methyltransferase [MGMT] status, second-line use of bevacizumab, and rCBVmax).
Log-rank tests revealed that age, KPS, MGMT status, and PSmax were significantly correlated with overall survival. Multivariate analysis using the Cox regression model showed that PSmax was the most significant prognostic factor. Receiver operating characteristic curve analysis showed that PSmax had the highest accuracy in differentiating longtime survivors (LTSs) (surviving more than 2 years) from non-LTSs. At a cutoff point of 8.26 mL/100 g/min, sensitivity and specificity were 90% and 70%, respectively.
PSmax from PCT study can help predict survival time in patients with GBM receiving the standard treatment protocol. Survival may be related to sensitivity to TMZ.
新诊断的胶质母细胞瘤（GBM）患者目前的标准治疗方案包括手术、放疗以及同步和辅助使用替莫唑胺（TMZ）。我们假设灌注计算机断层扫描（PCT）研究中的通透表面积乘积（PS）与对TMZ的敏感性相关。本研究的目的是确定PS值是否与接受标准治疗方案的GBM患者的预后相关。
本研究纳入了2005年10月至2014年9月期间新诊断的36例GBM患者，这些患者均接受了术前PCT研究和标准治疗方案。我们测量了相对脑血容量最大值（rCBVmax）和最大PS值（PSmax）。我们使用生存分析统计检验了PSmax与预后之间的关系，同时纳入了其他临床病理因素（年龄、卡诺夫斯基功能状态[KPS]、切除范围、O6-甲基鸟嘌呤-DNA甲基转移酶[MGMT]状态、贝伐单抗的二线使用以及rCBVmax）。
对数秩检验显示年龄、KPS、MGMT状态和PSmax与总生存期显著相关。使用Cox回归模型进行的多变量分析表明，PSmax是最显著的预后因素。受试者工作特征曲线分析表明，PSmax在区分长期生存者（LTSs，生存超过2年）和非LTSs方面具有最高的准确性。在截断点为8.26 mL/100 g/min时，敏感性和特异性分别为90%和70%。
PCT研究中的PSmax有助于预测接受标准治疗方案的GBM患者的生存时间。生存可能与对TMZ的敏感性有关。
