Stavrinou Pantelis, Kalyvas Aristotelis, Grau Stefan, Hamisch Christina, Galldiks Norbert, Katsigiannis Sotirios, Kabbasch Christoph, Timmer Marco, Goldbrunner Roland, Stranjalis George
1Department of Neurosurgery, University Hospital of Cologne, Germany.
2Department of Neurosurgery, Evangelismos Hospital, University of Athens, Greece.
J Neurosurg. 2018 Nov 30;131(4):1136-1141. doi: 10.3171/2018.7.JNS18228. Print 2019 Oct 1.
Data on the survival effects of supportive care compared to second-line multimodal treatment for glioblastoma progression are scarce. Thus, the authors assessed survival in two population-based, similar cohorts from two European university hospitals with different treatment strategies at first progression.
The authors retrospectively identified patients with newly diagnosed glioblastoma treated at two neurooncological centers. After diagnosis, patients from both centers received identical treatments, but at tumor progression each center used a different approach. In the majority of cases, at center A (Greece), supportive care or a single therapeutic modality was offered at progression, whereas center B (Germany) provided multimodal second-line therapy. The main outcome measure was survival after progression (SaP). The influence of the treatment strategy on SaP was assessed by multivariate analysis.
One hundred three patients from center A and 156 from center B were included. Tumor progression was observed in 86 patients (center A) and 136 patients (center B). At center A, 53 patients (72.6%) received supportive care alone, while at center B, 91 patients (80.5%) received second-line treatment. Progression-free survival at both centers was similar (9.4 months [center A] vs 9.0 months [center B]; p = 0.97), but SaP was significantly improved in the patients treated with multimodal second-line therapy at center B (7 months, 95% CI 5.3-8.7 months) compared to those treated with supportive care or a single therapeutic modality at center A (4.5 months, 95% CI 3.5-5.5 months; p = 0.003). In the multivariate analysis, the treatment center was an independent prognostic factor for overall survival (HR 1.59, 95% CI 0.17-2.15; p = 0.002).
Treatment strategy favoring multimodal second-line treatment over minimal treatment or supportive care at glioblastoma progression is associated with significantly better overall survival.
与胶质母细胞瘤进展的二线多模式治疗相比，支持性治疗的生存效果数据稀缺。因此，作者评估了来自两家欧洲大学医院的两个基于人群的、相似队列在首次进展时采用不同治疗策略后的生存情况。
作者回顾性确定了在两个神经肿瘤中心接受新诊断胶质母细胞瘤治疗的患者。诊断后，两个中心的患者接受相同的治疗，但在肿瘤进展时每个中心采用不同的方法。在大多数情况下，A中心（希腊）在进展时提供支持性治疗或单一治疗方式，而B中心（德国）提供多模式二线治疗。主要结局指标是进展后生存（SaP）。通过多变量分析评估治疗策略对SaP的影响。
纳入了A中心的103例患者和B中心的156例患者。A中心86例患者和B中心136例患者观察到肿瘤进展。在A中心，53例患者（72.6%）仅接受支持性治疗，而在B中心，91例患者（80.5%）接受二线治疗。两个中心的无进展生存期相似（A中心为9.4个月，B中心为9.0个月；p = 0.97），但与A中心接受支持性治疗或单一治疗方式的患者相比，B中心接受多模式二线治疗的患者的SaP显著改善（7个月，95%CI 5.3 - 8.7个月）（A中心为4.5个月，95%CI 3.5 - 5.5个月；p = 0.003）。在多变量分析中，治疗中心是总生存的独立预后因素（HR 1.59，95%CI 0.17 - 2.15；p = 0.002）。
在胶质母细胞瘤进展时，倾向于多模式二线治疗而非最小治疗或支持性治疗的治疗策略与显著更好的总生存相关。
