Eseonu Chikezie I, Eguia Francisco, ReFaey Karim, Garcia Oscar, Rodriguez Fausto J, Chaichana Kaisorn, Quinones-Hinojosa Alfredo
Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA.
Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.
J Neurooncol. 2017 Aug;134(1):65-74. doi: 10.1007/s11060-017-2486-9. Epub 2017 May 19.
The authors investigate the role of extent of resection (EOR) and genetic markers on patient outcome and survival for LGGs. We conducted a retrospective cohort between 2005 and 2015, of 109 adult patients who underwent surgery for a LGG by a single surgeon. Volumetric computations of MRI studies were conducted to evaluate the EOR, and genetic markers (IDH1, 1p/19q co-deletion, and p53) were assessed and their effects on survival and neurological outcome were evaluated. The median EOR was 88.1%. Permanent postoperative neurological deficits were seen in 4.6% of patients. EOR was a significant predictor for both overall survival (OS) (hazard ratio [HR] = 0.979, 95% CI 0.961-0.980, p = 0.029) and progression free survival (PFS) (HR = 0.982, 95% CI 0.968-0.997, p = 0.018). Malignant progression free survival (MPFS) was predicted by the 1p/19q co-deletion (HR = 0.148, 95% CI 0.019-1.148, p = 0.048). Patients with EOR of 100% had a significantly better OS than EOR less than 90% (p = 0.038). Patients with an EOR of at least 76% had a better OS than EOR less than 76% (p = 0.025). Patients with an EOR of at least 71% had a better PFS than EOR less than 71% (p = 0.030). Preoperative tumor volume was found to have significant association with EOR (R = 0.049, p = 0.031). Increased EOR is associated with improved OS and PFS survival outcomes, while 1p/19q co-deletion provides improved MPFS. Understanding both surgical resections and molecular markers of the tumor are important for effective management of LGG patients.
作者研究了切除范围（EOR）和基因标志物对低级别胶质瘤（LGG）患者预后和生存的作用。我们对2005年至2015年间由一名外科医生为109例LGG成年患者进行手术的情况进行了回顾性队列研究。通过对MRI研究进行体积计算来评估EOR，并评估基因标志物（异柠檬酸脱氢酶1（IDH1）、1p/19q共缺失和p53），并评估它们对生存和神经学结果的影响。EOR中位数为88.1%。4.6%的患者出现永久性术后神经功能缺损。EOR是总生存期（OS）（风险比[HR]=0.979，95%置信区间0.961 - 0.980，p = 0.029）和无进展生存期（PFS）（HR = 0.982，95%置信区间0.968 - 0.997，p = 0.018）的显著预测因素。1p/19q共缺失可预测无恶性进展生存期（MPFS）（HR = 0.148，95%置信区间0.019 - 1.148，p = 0.048）。EOR为100%的患者的OS明显优于EOR低于90%的患者（p = 0.038）。EOR至少为76%的患者的OS优于EOR低于76%的患者（p = 0.025）。EOR至少为71%的患者的PFS优于EOR低于71%的患者（p = 0.030）。发现术前肿瘤体积与EOR有显著关联（R = 0.049，p = 0.031）。EOR增加与OS和PFS生存结果改善相关，而1p/19q共缺失可改善MPFS。了解肿瘤手术切除情况和分子标志物对LGG患者的有效管理很重要。
