Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Neurosurgery. 2019 Dec 1;85(6):793-800. doi: 10.1093/neuros/nyy501.
Resection may be appropriate for select patients with recurrent glioblastoma. The incidence of histopathological findings related to prior treatment and their prognostic implications are incompletely characterized.
To quantify the incidence and survival outcomes associated with treatment effect at resection of recurrent glioblastoma (GBM).
Patients who underwent resection for recurrent GBM were retrospectively reviewed, and pathology, treatment history, and survival data were collected. Treatment effect was defined as any component of treatment-related changes on pathology.
In total, 110 patients underwent 146 reoperations. Median age at first reoperation was 57.2 yr and overall survival from reoperation was 10.8 mo. Treatment effect of any kind was noted in 81 of 146 reoperations (55%). Increased treatment effect was observed closer to radiotherapy; by quartile of time from radiotherapy, the rates of treatment effect were 77.8%, 55.6%, 40.7%, and 44.4% (P = .028). Treatment effect was associated with earlier reoperation (8.9 vs 13.8 mo after radiotherapy, P = .003), and the presence of treatment effect did not impact survival from primary surgery (25.4 vs 24.3 mo, P = .084). Patients treated with bevacizumab prior to reoperation were less likely to have treatment effect (20% vs 65%, P < .001).
Histopathological treatment-related changes are evident in a majority of patients undergoing resection for recurrent glioblastoma. There was no association of treatment effect with overall survival from primary surgery.
对于选择的复发性胶质母细胞瘤患者，可能适合进行切除。与既往治疗相关的组织病理学发现及其预后意义的发生率尚不完全清楚。
量化复发性胶质母细胞瘤（GBM）切除术中与治疗效果相关的发生率和生存结果。
回顾性分析接受复发性 GBM 切除术的患者，并收集病理学、治疗史和生存数据。将治疗效果定义为病理学上任何与治疗相关变化的组成部分。
共有 110 名患者接受了 146 次再次手术。首次再次手术的中位年龄为 57.2 岁，再次手术后的总生存时间为 10.8 个月。在 146 次再次手术中，有 81 次（55%）观察到任何类型的治疗效果。治疗效果越接近放疗时越明显；按放疗后时间的四分位数，治疗效果的发生率分别为 77.8%、55.6%、40.7%和 44.4%（P = 0.028）。治疗效果与再次手术时间更早有关（放疗后 8.9 和 13.8 个月，P = 0.003），治疗效果的存在并不影响原发性手术的生存（25.4 和 24.3 个月，P = 0.084）。在再次手术前接受贝伐单抗治疗的患者发生治疗效果的可能性较低（20%比 65%，P < 0.001）。
在接受复发性胶质母细胞瘤切除术的患者中，大多数患者存在与治疗相关的组织病理学变化。治疗效果与原发性手术的总体生存无关联。
