Fukui Atsushi, Muragaki Yoshihiro, Saito Taiichi, Maruyama Takashi, Nitta Masayuki, Ikuta Soko, Kawamata Takakazu
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
World Neurosurg. 2017 Feb;98:73-80. doi: 10.1016/j.wneu.2016.10.109. Epub 2016 Oct 29.
Extent of resection (EOR) remains controversial in therapy for glioblastoma (GBM). However, an increasing number of studies favor maximum EOR as being associated with longer patient survival. Residual tumor volume (RTV) has also recently emerged as a prognostic factor. Low-field intraoperative magnetic resonance imaging (iMRI) has contributed to improve the EOR of GBM. The purpose of this study was to analyze the relationships between EOR/RTV and overall survival (OS)/progression-free survival (PFS) in patients with newly diagnosed GBM using low-field iMRI.
Adult patients who underwent surgery for newly diagnosed supratentorial GBM between 2000 and 2012 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate analysis was used to evaluate the relationships between EOR/RTV and OS/PFS.
Of 168 patients, 126 (75%) died and 154 (91%) showed tumor recurrence. Median OS and PFS for patients with iMRI were 19.3 months (95% confidence interval, 15.4-23.7 months) and 9.5 months (95% confidence interval, 7.8-10.8 months). Median preoperative tumor volume was 37.0 cm (interquartile range [IQR], 19.9-59.8 cm). Median RTV was 0 cm (IQR, 0-1.6 cm). Median EOR was 100% (IQR, 96.2%-100%). In multivariate analysis, after controlling for age and Karnofsky Performance Status, EOR and RTV remained significantly associated with survival (hazard ratio, 1.56; P = 0.018) and recurrence (hazard ratio, 1.53; P = 0.013). Maximum RTV for survival was 3 cm.
This volumetric analysis for low-field iMRI showed that both EOR and RTV were significantly associated with survival and recurrence. We determined a threshold RTV of 3 cm as the maximum RTV associated with survival.
在胶质母细胞瘤（GBM）的治疗中，切除范围（EOR）仍存在争议。然而，越来越多的研究支持最大程度的EOR，因为这与患者更长的生存期相关。残余肿瘤体积（RTV）最近也成为一个预后因素。低场术中磁共振成像（iMRI）有助于提高GBM的EOR。本研究的目的是使用低场iMRI分析新诊断GBM患者的EOR/RTV与总生存期（OS）/无进展生存期（PFS）之间的关系。
回顾性分析2000年至2012年间因新诊断的幕上GBM接受手术的成年患者。进行三维肿瘤体积测量。采用多变量分析评估EOR/RTV与OS/PFS之间的关系。
168例患者中，126例（75%）死亡，154例（91%）出现肿瘤复发。接受iMRI检查患者的中位OS和PFS分别为19.3个月（95%置信区间，15.4 - 23.7个月）和9.5个月（95%置信区间，7.8 - 10.8个月）。术前肿瘤体积中位数为37.0 cm³（四分位间距[IQR]，19.9 - 59.8 cm³）。RTV中位数为0 cm³（IQR，0 - 1.6 cm³）。EOR中位数为100%（IQR，96.2% - 100%）。在多变量分析中，在控制年龄和卡诺夫斯基功能状态后，EOR和RTV仍与生存期（风险比，1.56；P = 0.018）和复发（风险比，1.53；P = 0.013）显著相关。生存的最大RTV为3 cm³。
这项针对低场iMRI的体积分析表明，EOR和RTV均与生存期和复发显著相关。我们确定3 cm³为与生存相关的最大RTV阈值。
