Jiang Haihui, Cui Yong, Liu Xiang, Ren Xiaohui, Li Mingxiao, Lin Song
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, and China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China; and.
2Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York.
J Neurosurg. 2019 Mar 22;132(4):998-1005. doi: 10.3171/2018.12.JNS182775. Print 2020 Apr 1.
The aim of this study was to investigate the relationship between extent of resection (EOR) and survival in terms of clinical, molecular, and radiological factors in high-grade astrocytoma (HGA).
Clinical and radiological data from 585 cases of molecularly defined HGA were reviewed. In each case, the EOR was evaluated twice: once according to contrast-enhanced T1-weighted images (CE-T1WI) and once according to fluid attenuated inversion recovery (FLAIR) images. The ratio of the volume of the region of abnormality in CE-T1WI to that in FLAIR images (VFLAIR/VCE-T1WI) was calculated and a receiver operating characteristic curve was used to determine the optimal cutoff value for that ratio. Univariate and multivariate analyses were performed to identify the prognostic value of each factor.
Both the EOR evaluated from CE-T1WI and the EOR evaluated from FLAIR could divide the whole cohort into 4 subgroups with different survival outcomes (p < 0.001). Cases were stratified into 2 subtypes based on VFLAIR/VCE-T1WI with a cutoff of 10: a proliferation-dominant subtype and a diffusion-dominant subtype. Kaplan-Meier analysis showed a significant survival advantage for the proliferation-dominant subtype (p < 0.0001). The prognostic implication has been further confirmed in the Cox proportional hazards model (HR 1.105, 95% CI 1.078-1.134, p < 0.0001). The survival of patients with proliferation-dominant HGA was significantly prolonged in association with extensive resection of the FLAIR abnormality region beyond contrast-enhancing tumor (p = 0.03), while no survival benefit was observed in association with the extensive resection in the diffusion-dominant subtype (p = 0.86).
VFLAIR/VCE-T1WI is an important classifier that could divide the HGA into 2 subtypes with distinct invasive features. Patients with proliferation-dominant HGA can benefit from extensive resection of the FLAIR abnormality region, which provides the theoretical basis for a personalized resection strategy.
本研究旨在探讨高级别星形细胞瘤（HGA）中切除范围（EOR）与临床、分子及放射学因素相关的生存情况之间的关系。
回顾了585例分子定义的HGA患者的临床和放射学数据。对每例患者的EOR进行两次评估：一次根据对比增强T1加权图像（CE-T1WI）评估，一次根据液体衰减反转恢复（FLAIR）图像评估。计算CE-T1WI上异常区域体积与FLAIR图像上异常区域体积之比（VFLAIR/VCE-T1WI），并使用受试者工作特征曲线确定该比值的最佳截断值。进行单因素和多因素分析以确定各因素的预后价值。
根据CE-T1WI评估的EOR和根据FLAIR评估的EOR均可将整个队列分为4个具有不同生存结局的亚组（p < 0.001）。根据VFLAIR/VCE-T1WI将病例分为2个亚型，截断值为10：增殖为主型和弥散为主型。Kaplan-Meier分析显示增殖为主型具有显著的生存优势（p < 0.0001）。Cox比例风险模型进一步证实了其预后意义（HR 1.105，95% CI 1.078 - 1.134，p < 0.0001）。增殖为主型HGA患者的生存时间显著延长与FLAIR异常区域超出对比增强肿瘤的广泛切除相关（p = 0.03），而弥散为主型亚组广泛切除未观察到生存获益（p = 0.86）。
VFLAIR/VCE-T1WI是一种重要的分类指标，可将HGA分为具有不同侵袭特征的2个亚型。增殖为主型HGA患者可从FLAIR异常区域的广泛切除中获益，这为个性化切除策略提供了理论依据。
