Yonezawa Hajime, Hirano Hirofumi, Uchida Hiroyuki, Habu Mika, Hanaya Ryosuke, Oyoshi Tatsuki, Sadamura Yuko, Hanada Tomoko, Tokimura Hiroshi, Moinuddin Fm, Arita Kazunori
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan.
Mol Clin Oncol. 2017 Jan;6(1):105-110. doi: 10.3892/mco.2016.1086. Epub 2016 Nov 18.
Bevacizumab (BEV), an inhibitor of vascular endothelial growth factor A, has been used for primary and recurrent malignant gliomas in Japan since June, 2013. Previous randomized controlled studies demonstrated that BEV prolonged the progression-free survival, but not the overall survival (OS) of patients with newly diagnosed glioblastoma. The aim of the present study was to elucidate the effect of BEV on the OS of patients with unresectable malignant gliomas. Of the 440 cases of malignant glioma initially treated in our institute between 2000 and 2015, 88 were not suitable for maximal resection due to patient age, physical condition, tumor location and extent, or the patient's wishes. Based on the biopsy results, the pathological diagnosis was glioblastoma, anaplastic astrocytoma and anaplastic oligodendroglioma in 60, 19 and 9 patients, respectively. Kaplan-Meier and log-rank analyses were performed to investigate the effect of BEV on OS. OS was longer in the BEV group (n=24) compared with that in the non-BEV group [n=64; median survival time (MST), 566 vs. 243 days, respectively; hazard ratio (HR)=0.413; 95% confidence interval (CI): 0.216-0.787; P=0.003]. In the 41 patients who received temozolomide (TMZ) and radiotherapy and the 31 patients with glioblastoma who received TMZ and radiotherapy, OS was longer in the BEV group compared with that in the non-BEV group (MST, 568 vs. 334 days, HR=0.404, 95% CI: 0.175-0.933, P=0.016; and MST, 566 vs. 160 days, HR=0.253, 95% CI: 0.099-0.646, P=0.001, respectively). In the Cox hazard model analysis of 41 patients who underwent TMZ-based chemoradiotherapy after biopsy, the use of BEV was the strongest independent beneficial factor associated with prolonged OS (HR=0.101; P=0.0002). Our retrospective survey suggested that BEV prolongs the OS of patients with unresectable malignant gliomas. However, these results must be verified by a well-designed prospective randomized controlled trial.
贝伐单抗（BEV）是一种血管内皮生长因子A抑制剂，自2013年6月起在日本被用于原发性和复发性恶性胶质瘤的治疗。既往随机对照研究表明，BEV可延长新诊断胶质母细胞瘤患者的无进展生存期，但不能延长总生存期（OS）。本研究的目的是阐明BEV对不可切除恶性胶质瘤患者OS的影响。在2000年至2015年间于我院接受初始治疗的440例恶性胶质瘤病例中，88例因患者年龄、身体状况、肿瘤位置和范围或患者意愿而不适合进行最大程度切除。根据活检结果，病理诊断为胶质母细胞瘤、间变性星形细胞瘤和间变性少突胶质细胞瘤的患者分别为60例、19例和9例。采用Kaplan-Meier法和对数秩检验分析BEV对OS的影响。与非BEV组相比，BEV组（n=24）的OS更长[n=64；中位生存时间（MST）分别为566天和243天；风险比（HR）=0.413；95%置信区间（CI）：0.216-0.787；P=0.003]。在41例接受替莫唑胺（TMZ）和放疗的患者以及31例接受TMZ和放疗的胶质母细胞瘤患者中，BEV组的OS也长于非BEV组（MST分别为568天和334天，HR=0.404，95%CI：0.175-0.933，P=0.016；以及MST分别为566天和160天，HR=0.253，95%CI：0.099-0.646，P=0.001）。在对41例活检后接受基于TMZ的放化疗的患者进行的Cox风险模型分析中，使用BEV是与延长OS相关的最强独立有益因素（HR=0.101；P=0.0002）。我们的回顾性研究表明，BEV可延长不可切除恶性胶质瘤患者的OS。然而，这些结果必须通过精心设计的前瞻性随机对照试验来验证。
