Carroll Kate T, Bryant Alex K, Hirshman Brian, Alattar Ali A, Joshi Rushikesh, Gabel Brandon, Carter Bob S, Harismendy Olivier, Vaida Florin, Chen Clark C
School of Medicine, University of California, San Diego, San Diego, California, USA.
Department of Neurosurgery, University of California, San Diego, San Diego, California, USA.
World Neurosurg. 2018 Mar;111:e790-e798. doi: 10.1016/j.wneu.2017.12.165. Epub 2018 Jan 5.
Gross total resection (GTR) in patients with glioblastoma (GB) and anaplastic astrocytoma (AA) is associated with improved survival. We examined how tumor location, tumor grade, and age affected this benefit.
We selected patients with lobar AA or GB in the Surveillance, Epidemiology, and End Results database from 1999 to 2010. Survival analyses were performed using Kaplan-Meier curves and Cox proportional hazards models.
We identified and studied 1429 patients with lobar AA and 12,537 patients with lobar GB in the Surveillance, Epidemiology, and End Results database. In multivariate Cox proportional hazards analysis, GTR of frontal lobe AA was associated with approximately 50% reduction in risk of death compared with subtotal resection (STR) (hazard ratio 0.51; 95% confidence interval, 0.36-0.73; P < 0.001). This hazard ratio corresponds to a median increase in overall survival of >8 years with GTR compared with STR. In nonfrontal AAs, there was no survival difference between GTR and STR (hazard ratio 0.79; 95% confidence interval, 0.58-1.08; P = 0.143). Location-specific survival benefit from GTR in AAs was significant in patients ≤50 years old but was not evident in patients >50 years old. In patients with GB, no location-dependent survival benefit with GTR was observed.
Our results demonstrate complex interaction between tumor grade, frontal lobe location, and age in their various contributions to survival benefit gained from GTR. The greatest survival benefit of GTR relative to STR was observed in patients ≤50 years old with frontal AAs.
胶质母细胞瘤（GB）和间变性星形细胞瘤（AA）患者的肿瘤全切除（GTR）与生存期改善相关。我们研究了肿瘤位置、肿瘤分级和年龄如何影响这一益处。
我们从1999年至2010年的监测、流行病学和最终结果数据库中选取了患有叶性AA或GB的患者。使用Kaplan-Meier曲线和Cox比例风险模型进行生存分析。
我们在监测、流行病学和最终结果数据库中识别并研究了1429例叶性AA患者和12537例叶性GB患者。在多变量Cox比例风险分析中，与次全切除（STR）相比，额叶AA的GTR与死亡风险降低约50%相关（风险比0.51；95%置信区间，0.36 - 0.73；P < 0.001）。与STR相比，该风险比对应的GTR患者总生存期的中位数增加超过8年。在非额叶AA中，GTR和STR之间无生存差异（风险比0.79；95%置信区间，0.58 - 1.08；P = 0.143）。AA中GTR的部位特异性生存益处在≤50岁的患者中显著，但在>50岁的患者中不明显。在GB患者中，未观察到GTR的部位依赖性生存益处。
我们的结果表明，肿瘤分级、额叶位置和年龄在它们对GTR获得的生存益处的各种贡献中存在复杂的相互作用。在≤50岁的额叶AA患者中观察到GTR相对于STR的最大生存益处。
