瘤周切除胶质母细胞瘤与改善预后独立相关。
Perilesional Resection of Glioblastoma Is Independently Associated With Improved Outcomes.
机构信息
Department of Neurosurgery, Wayne State University Medical School, Karmanos Cancer Institute, Detroit, Michigan.
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Neurosurgery. 2020 Jan 1;86(1):112-121. doi: 10.1093/neuros/nyz008.
BACKGROUND
Resection is a critical component in the initial treatment of glioblastoma (GBM). Often GBMs are resected using an intralesional method. Circumferential perilesional resection of GBMs has been described, but with limited data.
OBJECTIVE
To conduct an observational retrospective analysis to test whether perilesional resection produced a greater extent of resection.
METHODS
We identified all patients with newly diagnosed GBM who underwent resection at our institution from June 1, 1993 to December 31, 2015. Demographics, presenting symptoms, intraoperative data, method of resection (perilesional or intralesional), volumetric imaging data, and postoperative outcomes were obtained. Complete resection (CR) was defined as 100% resection of all contrast-enhancing disease. Univariate analyses employed analysis of variance (ANOVA) and Fisher's exact test. Multivariate analyses used propensity score-weighted multivariate logistic regression.
RESULTS
Newly diagnosed GBMs were resected in 1204 patients, 436 tumors (36%) perilesionally and 766 (64%) intralesionally. Radiographic CR was achieved in 69% of cases. Multivariate analysis demonstrated that perilesional tumor resection was associated with a significantly higher rate of CR than intralesional resection (81% vs 62%, multivariate odds ratio = 2.5, 95% confidence interval: 1.8-3.4, P < .001). Among tumors in eloquent cortex, multivariate analysis showed that patients who underwent perilesional resection had a higher rate of CR (79% vs 58%, respectively, P < .001) and a lower rate of neurological complications (11% vs 20%, respectively, P = .018) than those who underwent intralesional resection.
CONCLUSION
Circumferential perilesional resection of GBM is associated with significantly higher rates of CR and lower rates of neurological complications than intralesional resection, even for tumors arising in eloquent locations. Perilesional resection, when feasible, should be considered as a preferred option.
背景
切除是胶质母细胞瘤（GBM）初始治疗的关键组成部分。通常采用瘤内方法切除 GBM。已描述了 GBM 的环形近瘤切除，但数据有限。
目的
进行观察性回顾性分析，以测试近瘤切除是否能产生更大程度的切除。
方法
我们确定了 1993 年 6 月 1 日至 2015 年 12 月 31 日期间在我院接受切除治疗的所有新诊断为 GBM 的患者。获取人口统计学、临床表现、术中数据、切除方法（近瘤或瘤内）、容积成像数据和术后结果。完全切除（CR）定义为所有增强疾病的 100%切除。单变量分析采用方差分析（ANOVA）和 Fisher 确切检验。多变量分析采用倾向评分加权多变量逻辑回归。
结果
共切除 1204 例新诊断的 GBM，其中 436 例（36%）近瘤，766 例（64%）瘤内切除。69%的病例达到了影像学 CR。多变量分析表明，近瘤肿瘤切除与更高的 CR 率显著相关，而瘤内切除则较低（81%比 62%，多变量优势比 2.5，95%置信区间：1.8-3.4，P<0.001）。在大脑皮质功能区的肿瘤中，多变量分析显示，行近瘤切除的患者 CR 率更高（分别为 79%和 58%，P<0.001），神经并发症发生率更低（分别为 11%和 20%，P=0.018）。
结论
与瘤内切除相比，GBM 的环形近瘤切除与更高的 CR 率和更低的神经并发症发生率显著相关，即使是在大脑皮质功能区的肿瘤。可行时，应考虑近瘤切除作为首选方案。
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