Eseonu Chikezie I, ReFaey Karim, Garcia Oscar, Raghuraman Gugan, Quinones-Hinojosa Alfredo
Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
World Neurosurg. 2017 Jul;103:265-274. doi: 10.1016/j.wneu.2017.04.002. Epub 2017 Apr 10.
Insular gliomas are challenging tumors to surgically resect owing to the anatomy surrounding them. This study evaluates the role of extent of resection (EOR) and molecular markers in surgical outcome and survival for insular gliomas.
Seventy-four patients who had undergone initial resection for insular glioma by the same surgeon between 2006 and 2016 were analyzed. Low-grade gliomas (LGGs) (grade II) and high-grade gliomas (HGGs) (grade III/IV) were analyzed for the prognostic role of volumetric EOR and molecular markers in patient survival outcomes.
The cohort included 25 patients with LGGs (33.8%) and 49 patients with HGGs (66.2%). Median EOR was 91.7% (range, 10%-100%). New permanent postoperative deficits were found in 2.7% of patients. Patients with LGGs with ≥90% EOR had 5-year survival of 100%, and patients with <90% EOR had 5-year survival of 80%. Patients with HGGs with ≥90% EOR had 2-year survival of 83.7%, and patients with <90% EOR had 2-year survival of 43.8%. For LGGs, EOR was predictive of overall survival (P = 0.017), progression-free survival (PFS) (P = 0.039), and malignant PFS (P = 0.014), whereas 1p/19q codeletion was predictive of PFS (P = 0.014). For HGGs, EOR was predictive of overall survival (P = 0.020) and PFS (P = 0.024). Preoperative tumor volume most significantly affected EOR for insular gliomas (R = 0.053, P = 0.048).
Extensive resections of insular gliomas can be achieved with low morbidity and can improve overall survival and PFS. In this series of LGGs, EOR was associated with longer malignant PFS, and 1p/19q codeletion was predictive of PFS.
由于岛叶胶质瘤周围的解剖结构，手术切除具有挑战性。本研究评估了切除范围（EOR）和分子标志物在岛叶胶质瘤手术结果和生存中的作用。
分析了2006年至2016年间由同一位外科医生首次切除岛叶胶质瘤的74例患者。对低级别胶质瘤（LGGs，二级）和高级别胶质瘤（HGGs，三级/四级）分析了体积EOR和分子标志物在患者生存结果中的预后作用。
该队列包括25例LGGs患者（33.8%）和49例HGGs患者（66.2%）。EOR中位数为91.7%（范围10%-100%）。2.7%的患者出现了新的永久性术后缺陷。EOR≥90%的LGGs患者5年生存率为100%，EOR<90%的患者5年生存率为80%。EOR≥90%的HGGs患者2年生存率为83.7%，EOR<90%的患者2年生存率为43.8%。对于LGGs，EOR可预测总生存期（P = 0.017）、无进展生存期（PFS）（P = 0.039）和恶性PFS（P = 0.014），而1p/19q共缺失可预测PFS（P = 0.014）。对于HGGs，EOR可预测总生存期（P = 0.020）和PFS（P = 0.024）。术前肿瘤体积对岛叶胶质瘤的EOR影响最为显著（R = 0.053，P = 0.048）。
岛叶胶质瘤的广泛切除可以在低发病率的情况下实现，并可改善总生存期和PFS。在这一系列LGGs中，EOR与更长的恶性PFS相关，1p/19q共缺失可预测PFS。
