Department of Neurosurgery, Duke University, Durham, NC, USA.
Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, USA.
J Neurooncol. 2018 Sep;139(3):523-539. doi: 10.1007/s11060-018-2906-5. Epub 2018 May 23.
Although the majority of current medulloblastoma adjuvant therapy protocols treat patients with ≥ 1.5 cm residual tumor as high risk with increased craniospinal irradiation, the true prognostic significance of extent of resection (EOR) in medulloblastoma is unknown.
We sought to synthesize the body of literature on EOR and survival to determine if a definitive association exists.
DATA SOURCES/ELIGIBILITY CRITERIA: A PubMed search was conducted for the terms "medulloblastoma" combined with "extent of resection," "overall survival," "progression free survival," "gross total resection," "near total resection," "partial resection," or "subtotal resection." Studies that performed a statistical analysis of EOR and survival were included.
Sixteen articles including 1489 patients found a statistically significant association between EOR and survival, 20 articles including 2335 patients did not find a significant association between EOR and survival, and 14 articles including 2950 patients had mixed results. The three articles that accounted for molecular subgroup found varying associations between EOR and progression free survival, while no association was found between EOR and overall survival.
This review is limited by inconsistent definitions of EOR, the retrospective nature of the articles analyzed, and infrequent use of multivariate statistical analyses.
The prognostic importance of EOR for medulloblastoma is unclear and warrants re-evaluation, particularly in the context of molecular subgrouping.
尽管目前大多数髓母细胞瘤辅助治疗方案将有≥1.5cm 残余肿瘤的患者视为高危患者，增加颅脊髓照射，但肿瘤切除范围（EOR）在髓母细胞瘤中的真正预后意义尚不清楚。
我们试图综合 EOR 和生存的文献，以确定两者之间是否存在明确的关联。
资料来源/入选标准：在 PubMed 上使用“髓母细胞瘤”与“切除范围”、“总生存”、“无进展生存”、“大体全切除”、“近全切除”、“部分切除”或“次全切除”等术语进行搜索。纳入对 EOR 和生存进行统计学分析的研究。
16 篇文章（包括 1489 例患者）发现 EOR 与生存之间存在统计学显著关联，20 篇文章（包括 2335 例患者）未发现 EOR 与生存之间存在显著关联，14 篇文章（包括 2950 例患者）结果混杂。有 3 篇文章对分子亚组进行了分析，发现 EOR 与无进展生存之间存在不同的关联，而 EOR 与总生存之间没有关联。
本综述受到 EOR 定义不一致、分析文章的回顾性以及很少使用多变量统计分析的限制。
EOR 对髓母细胞瘤的预后意义尚不清楚，需要重新评估，特别是在分子亚组的背景下。
