Harsh G R, Levin V A, Gutin P H, Seager M, Silver P, Wilson C B
Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
Neurosurgery. 1987 Nov;21(5):615-21. doi: 10.1227/00006123-198711000-00002.
The advisability of a second operation for recurrent glioblastoma multiforme or anaplastic astrocytoma depends on the expected duration and quality of subsequent survival. We reviewed the results in 70 consecutive patients who underwent reoperation for supratentorial glioblastoma multiforme (n = 39) or anaplastic astrocytoma (n = 31) between 1975 and 1984. The operative morbidity rate was 5.7% (4 of 70 patients); the 6-week postoperative mortality rate was 4.3% (3 of 70 patients). The median duration of survival after reoperation was 36 weeks in patients with glioblastoma multiforme and 88 weeks in those with anaplastic astrocytoma. The median duration of high quality survival (defined as the period during which the patient had a Karnofsky performance score of at least 70) after reoperation was 10 weeks for patients with glioblastoma multiforme and 83 weeks for patients with anaplastic astrocytoma. Age and preoperative Karnofsky score in patients with glioblastoma multiforme and age in patients with anaplastic astrocytoma had statistically significant effects on the duration of high quality survival after reoperation, but not on postoperative survival independent of quality. Although age and functional status do not significantly affect the duration of survival after reoperation, they do have a significant effect on the quality of life after reoperation. Frequently, a patient can expect to spend a greater portion of his life at a higher level of function than he would have without reoperation. As adjunctive forms of therapy improve, reoperation will play an increasingly prominent role in the management of recurrent malignant astrocytic tumors.
对于复发性多形性胶质母细胞瘤或间变性星形细胞瘤而言，二次手术是否可行取决于后续生存的预期时长和质量。我们回顾了1975年至1984年间连续70例接受幕上多形性胶质母细胞瘤（n = 39）或间变性星形细胞瘤（n = 31）再次手术患者的结果。手术发病率为5.7%（70例患者中有4例）；术后6周死亡率为4.3%（70例患者中有3例）。多形性胶质母细胞瘤患者再次手术后的中位生存期为36周，间变性星形细胞瘤患者为88周。多形性胶质母细胞瘤患者再次手术后高质量生存期（定义为患者卡氏评分至少为70的时间段）的中位时长为10周，间变性星形细胞瘤患者为83周。多形性胶质母细胞瘤患者的年龄和术前卡氏评分以及间变性星形细胞瘤患者的年龄对再次手术后高质量生存期的时长有统计学显著影响，但对与质量无关的术后生存期没有影响。虽然年龄和功能状态对再次手术后的生存期时长没有显著影响，但它们对再次手术后的生活质量有显著影响。通常，与未进行再次手术相比，患者可以预期在更高功能水平下度过生命中更大的一部分时间。随着辅助治疗形式的改善，再次手术在复发性恶性星形细胞瘤的治疗中将发挥越来越突出的作用。
