Merkel Andreas, Soeldner Dorothea, Wendl Christina, Urkan Dilek, Kuramatsu Joji B, Seliger Corinna, Proescholdt Martin, Eyupoglu Ilker Y, Hau Peter, Uhl Martin
Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University of Regensburg, Regensburg, Germany.
J Neurooncol. 2017 Apr;132(2):249-254. doi: 10.1007/s11060-016-2362-z. Epub 2017 Jan 18.
Molecular markers define the diagnosis of glioblastoma in the new WHO classification of 2016, challenging neuro-oncology centers to provide timely treatment initiation. The aim of this study was to determine whether a time delay to treatment initiation was accompanied by signs of early tumor progression in an MRI before the start of radiotherapy, and, if so, whether this influences the survival of glioblastoma patients. Images from 61 patients with early post-surgery MRI and a second MRI just before the start of radiotherapy were examined retrospectively for signs of early tumor progression. Survival information was analyzed using the Kaplan-Meier method, and a Cox multivariate analysis was performed to identify independent variables for survival prediction. 59 percent of patients showed signs of early tumor progression after a mean time of 24.1 days from the early post-surgery MRI to the start of radiotherapy. Compared to the group without signs of early tumor progression, which had a mean time of 23.3 days (p = 0.685, Student's t test), progression free survival was reduced from 320 to 185 days (HR 2.3; CI 95% 1.3-4.0; p = 0.0042, log-rank test) and overall survival from 778 to 329 days (HR 2.9; CI 95% 1.6-5.1; p = 0.0005). A multivariate Cox regression analysis revealed that the Karnofsky performance score, O-6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation, and signs of early tumor progression are prognostic markers of overall survival. Early tumor progression at the start of radiotherapy is associated with a worse prognosis for glioblastoma patients. A standardized baseline MRI might allow for better patient stratification.
分子标志物在2016年世界卫生组织新分类中定义了胶质母细胞瘤的诊断，这对神经肿瘤中心提出了挑战，要求其及时开始治疗。本研究的目的是确定治疗开始时间的延迟是否伴随着放疗开始前MRI中早期肿瘤进展的迹象，如果是，这是否会影响胶质母细胞瘤患者的生存。回顾性检查了61例术后早期MRI及放疗开始前第二次MRI的患者图像，以寻找早期肿瘤进展的迹象。使用Kaplan-Meier方法分析生存信息，并进行Cox多变量分析以确定生存预测的独立变量。59%的患者在从术后早期MRI到放疗开始的平均24.1天时间后出现早期肿瘤进展迹象。与无早期肿瘤进展迹象的组相比，该组平均时间为23.3天（p = 0.685，Student t检验），无进展生存期从320天降至185天（HR 2.3；95%CI 1.3 - 4.0；p = 0.0042，对数秩检验），总生存期从778天降至329天（HR 2.9；95%CI 1.6 - 5.1；p = 0.0005）。多变量Cox回归分析显示，卡诺夫斯基表现评分、O-6-甲基鸟嘌呤-DNA-甲基转移酶（MGMT）启动子甲基化和早期肿瘤进展迹象是总生存的预后标志物。放疗开始时的早期肿瘤进展与胶质母细胞瘤患者预后较差相关。标准化的基线MRI可能有助于更好地对患者进行分层。
