Youssef Irini, Lee Anna, Garay Elizabeth L, Becker Daniel J, Schreiber David
Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA; Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.
J Clin Neurosci. 2018 Dec;58:124-129. doi: 10.1016/j.jocn.2018.09.010. Epub 2018 Oct 2.
It is unclear whether there is a survival benefit with postoperative radiation for low-grade gliomas deemed to be high-risk. We sought to analyze patterns of care and outcomes of radiation use. We accessed the National Cancer Database to identify patients with WHO grade II oligodendroglioma or astrocytoma between 2010 and 2012. Multivariable logistic regression was used to identify predictors of radiation use and multivariable Cox regression was used to identify covariables associated with differences in survival. There were 1952 patients included in this study, of which 518 (26.5%) received postoperative radiation. The majority had oligodendroglioma histology (n = 1121, 57.4%) compared to astrocytoma (n = 831, 42.6%). There were 1626 patients who were either ≥40 years old or underwent a subtotal resection ("high-risk"), and from these 495 (30.4%) received postoperative radiation. On multivariable logistic regression treatment at an academic facility (OR 0.72) was associated with a lower likelihood of receiving postoperative radiation. Astrocytoma histology (OR 2.08), age ≥40 years (OR 2.23), tumor size ≥6 cm (OR 1.64), subtotal resection (OR 1.55), and chemotherapy use (OR 3.93) were associated with an increased likelihood of postoperative radiation. On multivariable analysis, astrocytoma histology (HR 3.49, p < 0.001) and receipt of radiation (HR 2.06, p < 0.001) were associated with worse overall survival. GTR (HR 0.51, p = 0.001) was associated with improved overall survival. Patients treated in United States hospitals are not routinely referred for postoperative radiation for high-risk, low-grade gliomas. Patients who received radiation did not do better than those who did not receive radiation.
对于被认为具有高风险的低级别胶质瘤，术后放疗是否能带来生存获益尚不清楚。我们试图分析放疗的使用模式和结果。我们访问了国家癌症数据库，以确定2010年至2012年间患有世界卫生组织二级少突胶质细胞瘤或星形细胞瘤的患者。多变量逻辑回归用于确定放疗使用的预测因素，多变量Cox回归用于确定与生存差异相关的协变量。本研究纳入了1952例患者，其中518例（26.5%）接受了术后放疗。与星形细胞瘤（n = 831，42.6%）相比，大多数患者的组织学类型为少突胶质细胞瘤（n = 1121，57.4%）。有1626例患者年龄≥40岁或接受了次全切除（“高风险”），其中495例（30.4%）接受了术后放疗。在多变量逻辑回归中，在学术机构接受治疗（OR 0.72）与接受术后放疗的可能性较低相关。星形细胞瘤组织学类型（OR 2.08）、年龄≥40岁（OR 2.23）、肿瘤大小≥6 cm（OR 1.64）、次全切除（OR 1.55）和使用化疗（OR 3.93）与术后放疗的可能性增加相关。在多变量分析中，星形细胞瘤组织学类型（HR 3.49，p < 0.001）和接受放疗（HR 2.06，p < 0.001）与较差的总生存期相关。大体肿瘤切除（GTR，HR 0.51，p = 0.001）与总生存期改善相关。在美国医院接受治疗的患者对于高风险低级别胶质瘤通常不会常规接受术后放疗。接受放疗的患者并不比未接受放疗的患者情况更好。
