Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia.
Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Cancer. 2018 Mar 15;124(6):1169-1178. doi: 10.1002/cncr.31158. Epub 2017 Dec 4.
The addition of chemotherapy to adjuvant radiotherapy (chemotherapy and radiation therapy [CRT]) improves overall survival (OS) for patients with high-risk grade 2 gliomas; however, the impact of chemotherapy alone (CA) is unknown. This study compares the OS of patients with high-risk grade 2 gliomas treated with CA versus CRT.
Patients with high-risk grade 2 gliomas (subtotal resection or age ≥ 40 years) with oligodendrogliomas, astrocytomas, or mixed tumors were identified with the National Cancer Data Base. Patients were grouped into CA and CRT cohorts. Univariate analyses and multivariate analyses (MVAs) were performed. Propensity score (PS) matching was also implemented. The Kaplan-Meier method was used to analyze OS.
A total of 1054 patients with high-risk grade 2 gliomas were identified: 496 (47.1%) received CA, and 558 (52.9%) received CRT. Patients treated with CA were more likely (all P values < .05) to have oligodendroglioma histology (65.5% vs 34.2%), exhibit a 1p/19q codeletion (22.8% vs 7.5%), be younger (median age, 47.0 vs 48.0 years), and receive treatment at an academic facility (65.2% vs 50.3%). The treatment type was not a significant predictor for OS (P = .125) according to the MVA; a tumor size > 6 cm, astrocytoma histology, and older age were predictors for worse OS (all P values < .05). After 1:1 PS matching (n = 331 for each cohort), no OS difference was seen (P = .696) between the CA and CRT cohorts at 5 (69.3% vs 67.4%) and 8 years (52.8% vs 56.7%).
No long-term OS difference was seen in patients with high-risk grade 2 gliomas treated with CA versus CRT. These findings are hypothesis-generating, and prospective clinical trials comparing these treatment paradigms are warranted. Cancer 2018;124:1169-78. © 2017 American Cancer Society.
辅助放化疗（化疗和放疗[CRT]）可提高高危 2 级胶质瘤患者的总生存期（OS）；然而，单独化疗（CA）的影响尚不清楚。本研究比较了高危 2 级胶质瘤患者接受 CA 与 CRT 的 OS。
利用国家癌症数据库，确定了接受次全切除或年龄≥40 岁的高危 2 级少突胶质细胞瘤、星形细胞瘤或混合瘤患者。将患者分为 CA 和 CRT 两组。进行单因素分析和多因素分析（MVA）。还进行了倾向评分（PS）匹配。采用 Kaplan-Meier 法分析 OS。
共确定了 1054 例高危 2 级胶质瘤患者：496 例（47.1%）接受 CA，558 例（52.9%）接受 CRT。接受 CA 治疗的患者更有可能（所有 P 值均<.05）具有少突胶质细胞瘤组织学（65.5%比 34.2%）、存在 1p/19q 联合缺失（22.8%比 7.5%）、年龄更小（中位年龄 47.0 岁比 48.0 岁）、在学术机构接受治疗（65.2%比 50.3%）。MVA 显示，治疗类型不是 OS 的显著预测因素（P=0.125）；肿瘤大小>6cm、星形细胞瘤组织学和年龄较大是 OS 较差的预测因素（所有 P 值均<.05）。经 1:1 PS 匹配（每组 n=331）后，CA 和 CRT 两组在 5 年（69.3%比 67.4%）和 8 年（52.8%比 56.7%）时未见 OS 差异（P=0.696）。
高危 2 级胶质瘤患者接受 CA 与 CRT 治疗后未见长期 OS 差异。这些发现具有启发性，需要进行比较这些治疗方案的前瞻性临床试验。癌症 2018；124：1169-78。©2017 美国癌症协会。
