超全切除胶质母细胞瘤与患者生存的关系：系统评价和荟萃分析。

Association Between Supratotal Glioblastoma Resection and Patient Survival: A Systematic Review and Meta-Analysis.

机构信息

Department of Neurosurgery, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Department of Radiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.

出版信息

World Neurosurg. 2019 Jul;127:617-624.e2. doi: 10.1016/j.wneu.2019.04.092. Epub 2019 Apr 17.

DOI:10.1016/j.wneu.2019.04.092

PMID:31004858

Abstract

BACKGROUND

Gross total resection (GTR) of the contrast enhancing (CE) area will improve the survival of patients with glioblastoma (GBM). However, GBM can infiltrate into the brain parenchyma, beyond the CE margins. It remains unclear whether resection beyond the CE area (supratotal resection [SPTR]) can improve survival without causing additional neurological deficits. The aim of the present meta-analysis was to study the association between SPTR and overall survival of patients of GBM.

METHODS

Embase, PubMed, and other literature databases were searched for eligible studies until August 2018. Studies involving patients with GBM that had compared SPTR with GTR were included in the present study. The main outcome was overall survival, presented as hazard ratios (HRs) with 95% confidence intervals (CIs) and median overall survival differences with the 95% CIs.

RESULTS

The meta-analysis, which included 6 studies and 1168 unique patients with GBM, showed that compared with GTR, SPTR of GBM resulted in a 53% lower risk of mortality at any time during follow-up (HR, 0.47; 95% CI, 0.31-0.72; P = 0.0005). The median overall survival of the SPTR group was 6.4 months (95% CI, 3.2-9.7) longer than the GTR group (P = 0.0001). Reports on postoperative deficits were limited, and the quality of evidence was moderate to very low.

CONCLUSIONS

Compared with GTR, SPTR of GBM resulted in a lower risk of mortality and longer median overall survival. However, the quality of evidence of the available studies was poor. Therefore, it remains unclear whether SPTR is safe and actually improves the survival of patients with GBM. Future prospective trials and a standardized definition of SPTR are needed.

摘要

背景

全切除（GTR）增强对比（CE）区域将提高胶质母细胞瘤（GBM）患者的生存率。然而，GBM 可以渗透到脑实质，超出 CE 边界。目前尚不清楚在 CE 区域之外进行切除（超全切除[SPTR]）是否可以在不引起额外神经功能缺损的情况下提高生存率。本荟萃分析的目的是研究 SPTR 与 GBM 患者总生存率之间的关系。

方法

检索 Embase、PubMed 和其他文献数据库，直到 2018 年 8 月，以获取符合条件的研究。本研究纳入了比较 SPTR 与 GTR 的 GBM 患者的研究。主要结局是总生存率，表现为风险比（HRs）及其 95%置信区间（CIs）和中位数总生存差异及其 95%CI。

结果

纳入 6 项研究和 1168 例 GBM 患者的荟萃分析显示，与 GTR 相比，GBM 的 SPTR 使任何随访时间的死亡率降低了 53%（HR，0.47；95%CI，0.31-0.72；P = 0.0005）。SPTR 组的中位总生存期比 GTR 组长 6.4 个月（95%CI，3.2-9.7；P = 0.0001）。关于术后缺陷的报道有限，证据质量为中等到极低。