Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas.
Depart-ment of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Neurosurgery. 2018 Jun 1;82(6):808-814. doi: 10.1093/neuros/nyx265.
Maximizing extent of resection (EOR) improves outcomes in adults with World Health Organization (WHO) grade II low-grade gliomas (LGG). However, recent studies demonstrate that LGGs bearing a mutation in the isocitrate dehydrogenase 1 (IDH1) gene are a distinct molecular and clinical entity. It remains unclear whether maximizing EOR confers an equivalent clinical benefit in IDH mutated (mtIDH) and IDH wild-type (wtIDH) LGGs.
To assess the impact of EOR on malignant progression-free survival (MPFS) and overall survival (OS) in mtIDH and wtIDH LGGs.
We performed a retrospective review of 74 patients with WHO grade II gliomas and known IDH mutational status undergoing resection at a single institution. EOR was assessed with quantitative 3-dimensional volumetric analysis. The effect of predictor variables on MPFS and OS was analyzed with Cox regression models and the Kaplan-Meier method.
Fifty-two (70%) mtIDH patients and 22 (30%) wtIDH patients were included. Median preoperative tumor volume was 37.4 cm3; median EOR of 57.6% was achieved. Univariate Cox regression analysis confirmed EOR as a prognostic factor for the entire cohort. However, stratifying by IDH status demonstrates that greater EOR independently prolonged MPFS and OS for wtIDH patients (hazard ratio [HR] = 0.002 [95% confidence interval {CI} 0.000-0.074] and HR = 0.001 [95% CI 0.00-0.108], respectively), but not for mtIDH patients (HR = 0.84 [95% CI 0.17-4.13] and HR = 2.99 [95% CI 0.15-61.66], respectively).
Increasing EOR confers oncologic and survival benefits in IDH1 wtLGGs, but the impact on IDH1 mtLGGs requires further study.
最大限度地切除肿瘤（EOR）可改善世界卫生组织（WHO）分级 II 级低级别胶质瘤（LGG）患者的预后。然而，最近的研究表明，携带异柠檬酸脱氢酶 1（IDH1）基因突变的 LGG 是一种独特的分子和临床实体。目前尚不清楚在 IDH 突变（mtIDH）和 IDH 野生型（wtIDH）LGG 中，最大限度地切除肿瘤是否能带来等效的临床获益。
评估 EOR 对 mtIDH 和 wtIDH LGG 患者的恶性无进展生存期（MPFS）和总生存期（OS）的影响。
我们对在单机构行切除术的 74 例 WHO 分级 II 级胶质瘤且已知 IDH 突变状态的患者进行了回顾性研究。通过定量 3 维容积分析评估 EOR。采用 Cox 回归模型和 Kaplan-Meier 方法分析预测变量对 MPFS 和 OS 的影响。
52 例（70%）mtIDH 患者和 22 例（30%）wtIDH 患者入组。术前肿瘤体积中位数为 37.4cm3；EOR 中位数为 57.6%。单因素 Cox 回归分析证实 EOR 是整个队列的预后因素。但是，按 IDH 状态分层显示，更大的 EOR 可独立延长 wtIDH 患者的 MPFS 和 OS（风险比[HR] = 0.002[95%置信区间 {CI} 0.000-0.074]和 HR = 0.001[95% CI 0.00-0.108]），但对 mtIDH 患者无影响（HR = 0.84[95% CI 0.17-4.13]和 HR = 2.99[95% CI 0.15-61.66]）。
增加 EOR 可使 IDH1 wtLGG 获得肿瘤学和生存获益，但对 IDH1 mtLGG 的影响需要进一步研究。
