Olivia Newton-John Cancer & Wellness Research Centre, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.
Department of Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia.
J Neurooncol. 2018 Apr;137(2):409-415. doi: 10.1007/s11060-017-2731-2. Epub 2018 Jan 2.
Studies looking at the benefit of surgery at first relapse (second surgery) for recurrent glioblastoma were confounded by including patients with varying grades of glioma, performance status and extent of resection. This case-controlled study aims to remove these confounders to assess the survival impact of second surgery in recurrent glioblastoma. Retrospective data on patients with glioblastoma recurrence at two tertiary Australian hospitals from July 2009 to April 2015 was reviewed. Patients who had surgery at recurrence were matched with those who did not undergo surgery at recurrence, based on the extent of their initial resection and age. Overall survival (OS1 assessed from initial diagnosis and OS2 from the date of recurrence) as well as functional outcomes after resection were analysed. There were 120 patients (60 in each institution); median age at diagnosis was 56 years. Median OS1 was 14 months (95% CI 11.5-15.7) versus 22 months (95% CI 18-25) in patients who did not undergo second surgery and those with surgery at recurrence. OS2 was improved by second surgery (4.7 vs 9.6, HR 0.52, 95% CI 0.38-0.72, P < 0.001), and by chemotherapy, given at recurrence, (HR 0.47, 95% CI 0.24-0.92, P = 0.03). After second surgery, 80% did not require rehabilitation and 61% were independently mobile. Second surgery for recurrent glioblastoma was associated with a survival advantage. Chemotherapy independent of surgery, also improved survival. Functional outcomes were encouraging. More research is required in the era of improved surgical techniques and new antineoplastic therapies.
研究表明，对于复发性胶质母细胞瘤患者，初次复发时（二次手术）手术的获益受到肿瘤分级、功能状态和切除范围不同的混杂因素的影响。本病例对照研究旨在消除这些混杂因素，以评估复发性胶质母细胞瘤二次手术对患者生存的影响。回顾了 2009 年 7 月至 2015 年 4 月在澳大利亚两家三级医院就诊的胶质母细胞瘤复发患者的回顾性数据。根据初次切除范围和年龄，对复发时行手术的患者与未行手术的患者进行了匹配。分析了从初始诊断开始的总生存期（OS1）和从复发开始的总生存期（OS2）以及切除后的功能结局。共纳入 120 例患者（每家医院 60 例）；诊断时的中位年龄为 56 岁。未行二次手术的患者中位 OS1 为 14 个月（95%CI，11.5-15.7），而行二次手术的患者中位 OS1 为 22 个月（95%CI，18-25）。二次手术可改善 OS2（4.7 比 9.6，HR 0.52，95%CI 0.38-0.72，P<0.001），以及复发时给予的化疗（HR 0.47，95%CI 0.24-0.92，P=0.03）。二次手术后，80%的患者无需康复治疗，61%的患者能够独立移动。复发性胶质母细胞瘤的二次手术与生存获益相关。独立于手术的化疗也可改善生存。功能结局令人鼓舞。在手术技术改进和新型抗肿瘤治疗的时代，需要开展更多的研究。
