Di Carlo Davide Tiziano, Cagnazzo Federico, Benedetto Nicola, Morganti Riccardo, Perrini Paolo
Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy.
Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy.
Neurosurg Rev. 2019 Jun;42(2):263-275. doi: 10.1007/s10143-017-0928-7. Epub 2017 Nov 14.
Multiple high-grade gliomas (M-HGGs) are well--separated tumors, differentiated as multifocal (MF) and multicentric (MC) by their MRI features. The authors performed a systematic review and meta-analysis of literature examining epidemiology, clinical and radiological characteristics, management, and the overall survival from M-HGGs. According to PRISMA guidelines, a comprehensive review of studies published between January 1990 and January 2017 was carried out. The authors identified studies that examined the prevalence rate, clinical and radiological characteristics, treatment, and overall survival from M-HGGs in patients with HGG. Data were analyzed using a random-effects meta-analysis model. Finally, we systematically reviewed demographic characteristics, lesion location, and surgical and adjuvant treatments. Twenty-three studies were included in this systematic review. The M-HGGs prevalence rate was 19% (95% CI 13-26%) and the hazard ratio of death from M-HGGs in the HGGs population was 1.71 (95% CI 1.49-1.95, p < 0.0001). The MC prevalence rate was 6% (CI 95% 4-10%), whereas MF prevalence rate was 11% (CI 95% 6-20%) (p < 0.0001). There were no statistically significant differences between MF and MC HGGs in gender, lesion location, histological type, and surgical treatment. Survival analysis of MC tumors showed that surgical resection (gross total resection or subtotal resection) is an independent predictor of improved outcome (HR 7.61 for biopsy subgroup, 95% CI 1.94-29.78, p = 0.004). The prevalence of M-HGGs is approximately 20% of HGGs. The clinical relevance of separating M-HGGs in MF and MC tumors remains questionable and its prognostic significance is unclear. When patient status and lesion characteristics make it safe and feasible, cytoreduction should be attempted in patients with M-HGGs because it improves overall survival.
多发性高级别胶质瘤（M-HGGs）是界限分明的肿瘤，根据其MRI特征可分为多灶性（MF）和多中心性（MC）。作者对有关M-HGGs的流行病学、临床和放射学特征、治疗及总生存期的文献进行了系统综述和荟萃分析。根据PRISMA指南，对1990年1月至2017年1月发表的研究进行了全面回顾。作者确定了研究HGG患者中M-HGGs的患病率、临床和放射学特征、治疗及总生存期的研究。使用随机效应荟萃分析模型对数据进行分析。最后，我们系统回顾了人口统计学特征、病变位置以及手术和辅助治疗情况。本系统综述纳入了23项研究。M-HGGs的患病率为19%（95%CI 13-26%），HGG人群中M-HGGs的死亡风险比为1.71（95%CI 1.49-1.95，p<0.0001）。MC的患病率为6%（95%CI 4-10%），而MF的患病率为11%（95%CI 6-20%）（p<0.0001）。MF和MC HGGs在性别、病变位置、组织学类型和手术治疗方面无统计学显著差异。MC肿瘤的生存分析表明，手术切除（大体全切除或次全切除）是改善预后的独立预测因素（活检亚组的HR为7.61，95%CI 1.94-29.78，p=0.004）。M-HGGs的患病率约为HGGs的20%。将M-HGGs分为MF和MC肿瘤的临床相关性仍存在疑问，其预后意义尚不清楚。当患者状况和病变特征安全可行时，应尝试对M-HGGs患者进行减瘤治疗，因为这可改善总生存期。
