Roh Tae Hoon, Kang Seok-Gu, Moon Ju Hyung, Sung Kyoung Su, Park Hun Ho, Kim Se Hoon, Kim Eui Hyun, Hong Chang-Ki, Suh Chang-Ok, Chang Jong Hee
1Yonsei University Graduate School, Seoul.
2Department of Neurosurgery, Brain Tumor Center, Ajou University Hospital, Ajou University School of Medicine, Suwon.
J Neurosurg. 2019 Mar 1;132(3):895-901. doi: 10.3171/2018.12.JNS182558. Print 2020 Mar 1.
Following resection of glioblastoma (GBM), microscopic remnants of the GBM tumor remaining in nearby tissue cause tumor recurrence more often than for other types of tumors, even after gross-total resection (GTR). Although surgical oncologists traditionally resect some of the surrounding normal tissue, whether further removal of nearby tissue may improve survival in GBM patients is unknown. In this single-center retrospective study, the authors assessed whether lobectomy confers a survival benefit over GTR without lobectomy when treating GBMs in the noneloquent area.
The authors selected 40 patients who had undergone GTR of a histopathologically diagnosed isocitrate dehydrogenase (IDH)-wild type GBM in the right frontal or temporal lobe and divided the patients into 2 groups according to whether GTR of the tumor involved lobectomy, defined as a supratotal resection (SupTR group, n = 20) or did not (GTR group, n = 20). Progression-free survival (PFS), overall survival (OS), and Karnofsky Performance Status (KPS) scores were compared between groups (p ≤ 0.05 for statistically significant differences).
The median postoperative PFS times for each group were as follows: GTR group, 11.5 months (95% CI 8.8-14.2) and SupTR group, 30.7 months (95% CI 4.3-57.1; p = 0.007). The median postoperative OS times for each group were as follows: GTR group, 18.7 months (95% CI 14.3-23.1) and SupTR group, 44.1 months (95% CI 25.1-63.1; p = 0.040). The mean postoperative KPS scores (GTR, 76.5; SupTR, 77.5; p = 0.904) were not significantly different. In multivariate analysis, survival for the SupTR group was significantly longer than that for the GTR group in terms of both PFS (HR 0.230; 95% CI 0.090-0.583; p = 0.002) and OS (HR 0.247; 95% CI 0.086-0.704; p = 0.009).
In cases of completely resectable, noneloquent-area GBMs, SupTR provides superior PFS and OS without negatively impacting patient performance.
胶质母细胞瘤（GBM）切除术后，即使进行了大体全切（GTR），残留于附近组织中的GBM肿瘤微小残余灶导致肿瘤复发的频率也高于其他类型肿瘤。尽管外科肿瘤学家传统上会切除一些周围正常组织，但进一步切除附近组织是否能提高GBM患者的生存率尚不清楚。在这项单中心回顾性研究中，作者评估了在治疗非功能区GBM时，肺叶切除术相较于未行肺叶切除术的GTR是否能带来生存获益。
作者选取了40例经组织病理学诊断为异柠檬酸脱氢酶（IDH）野生型GBM且在右侧额叶或颞叶接受了GTR的患者，并根据肿瘤的GTR是否涉及肺叶切除术（定义为超全切除，超全切除组，n = 20）将患者分为两组，未涉及肺叶切除术的为GTR组（n = 20）。比较两组的无进展生存期（PFS）、总生存期（OS）和卡诺夫斯基功能状态（KPS）评分（p≤0.05为差异有统计学意义）。
每组术后中位PFS时间如下：GTR组为11.5个月（95%CI 8.8 - 14.2），超全切除组为30.7个月（95%CI 4.3 - 57.1；p = 0.007）。每组术后中位OS时间如下：GTR组为18.7个月（95%CI 14.3 - 23.1），超全切除组为44.1个月（95%CI 25.1 - 63.1；p = 0.040）。术后平均KPS评分（GTR组为76.5，超全切除组为77.5；p = 0.904）无显著差异。在多变量分析中，就PFS（风险比[HR]0.230；95%CI 0.090 - 0.583；p = 0.002）和OS（HR 0.247；95%CI 0.086 - 0.704；p = 0.009）而言，超全切除组的生存期显著长于GTR组。
在可完全切除的非功能区GBM病例中，超全切除可提供更好的PFS和OS，且对患者的功能状态无负面影响。
