Müller Domenique M J, Robe Pierre A J T, Eijgelaar Roelant S, Witte Marnix G, Visser Martin, de Munck Jan C, Broekman Marieke L D, Seute Tatjana, Hendrikse Jeroen, Noske David P, Vandertop William P, Barkhof Frederik, Kouwenhoven Mathilde C M, Mandonnet Emmanuel, Berger Mitchel S, De Witt Hamer Philip C
Vrije Universiteit Medical Center, Amsterdam, the Netherlands.
University Medical Center Utrecht, Utrecht, the Netherlands.
JCO Clin Cancer Inform. 2019 Jan;3:1-12. doi: 10.1200/CCI.18.00089.
The aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity, which depends on the location within the brain. A standard to compare these decisions is lacking. We present a volumetric voxel-wise method for direct comparison between two multidisciplinary teams of glioblastoma surgery decisions throughout the brain.
Adults undergoing first-time glioblastoma surgery from 2012 to 2013 performed by two neuro-oncologic teams were included. Patients had had a diagnostic biopsy or resection. Preoperative tumors and postoperative residues were segmented on magnetic resonance imaging in three dimensions and registered to standard brain space. Voxel-wise probability maps of tumor location, biopsy, and resection were constructed for each team to compare patient referral bias, indication variation, and treatment variation. To evaluate the quality of care, subgroups of differentially resected brain regions were analyzed for survival and functional outcome.
One team included 101 patients, and the other included 174; 91 tumors were biopsied, and 181 were resected. Patient characteristics were largely comparable between teams. Distributions of tumor locations were dissimilar, suggesting referral bias. Distributions of biopsies were similar, suggesting absence of indication variation. Differentially resected regions were identified in the anterior limb of the right internal capsule and the right caudate nucleus, indicating treatment variation. Patients with (n = 12) and without (n = 6) surgical removal in these regions had similar overall survival and similar permanent neurologic deficits.
Probability maps of tumor location, biopsy, and resection provide additional information that can inform surgical decision making across multidisciplinary teams for patients with glioblastoma.
胶质母细胞瘤手术的目标是在保留功能完整性的同时最大化切除范围，而这取决于肿瘤在脑内的位置。目前缺乏用于比较这些决策的标准。我们提出一种基于体素的体积分析方法，用于直接比较两个多学科团队对全脑胶质母细胞瘤手术决策的差异。
纳入2012年至2013年由两个神经肿瘤团队进行首次胶质母细胞瘤手术的成年患者。患者均接受过诊断性活检或切除术。术前肿瘤和术后残留通过磁共振成像进行三维分割，并配准到标准脑空间。为每个团队构建肿瘤位置、活检和切除的体素概率图，以比较患者转诊偏倚、适应证差异和治疗差异。为评估医疗质量，对不同切除脑区的亚组进行生存和功能结局分析。
一个团队纳入101例患者，另一个团队纳入174例；91例肿瘤接受活检，181例接受切除。两个团队的患者特征基本可比。肿瘤位置分布不同，提示存在转诊偏倚。活检分布相似，提示不存在适应证差异。在右侧内囊前肢和右侧尾状核中发现了不同的切除区域，表明存在治疗差异。在这些区域接受手术切除（n = 12）和未接受手术切除（n = 6）的患者总体生存率相似，永久性神经功能缺损也相似。
肿瘤位置、活检和切除的概率图提供了额外信息，可为多学科团队对胶质母细胞瘤患者的手术决策提供参考。
