Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
School of Medicine, Vanderbilt University, Nashville, Tennessee.
Neurosurgery. 2019 Nov 1;85(5):E924-E932. doi: 10.1093/neuros/nyz144.
Ventricular entry during glioblastoma resection and tumor contact with the subventricular zone (SVZ) have both been shown to associate with development of hydrocephalus, leptomeningeal dissemination, distant parenchymal recurrence, and decreased survival. However, prior studies did not analyze these variables together in a single-patient population; therefore, it is unknown which is an independent predictor of these outcomes.
To conduct a comparative outcome analysis of surgical ventricular entry and SVZ contact by glioblastoma in a retrospective cohort of 232 patients.
Outcomes studied included hydrocephalus, leptomeningeal dissemination, distant tumor recurrences, and progression-free (PFS) and overall (OS) survival. The Cox proportional regression analyses were adjusted for age at diagnosis, preoperative Karnofsky performance status score, extent of resection, temozolomide and radiation treatments, and tumor molecular status (specifically, IDH1/2 mutation and MGMT promoter methylation).
Surgical ventricular entry, SVZ-contacting glioblastoma, hydrocephalus, leptomeningeal dissemination, and distant recurrences were observed in 85 (36.6%), 114 (49.1%), 19 (8.2%), 78 (33.6%), and 59 (25.4%) patients, respectively. Multivariate, adjusted analysis revealed SVZ tumor contact-but not ventricular entry-associated with hydrocephalus (hazard ratio, HR, 4.20 [1.13-15.7], P = .03), leptomeningeal dissemination (HR 1.93 [1.14-3.28], P = .01), PFS (HR 2.10 [1.53-2.88], P < .001), and OS (HR 1.90 [1.35-2.67], P < .001). Distant recurrences were not associated with either. No interaction between the 2 variables was statistically noted.
SVZ contact by glioblastoma was independently associated with the development of hydrocephalus, leptomeningeal dissemination, and decreased survival. SVZ tumor contact was associated with ventricular entry during surgical resections, which did not independently correlate with these outcomes.
脑胶质母细胞瘤切除术中的脑室进入以及与侧脑室下区（SVZ）的肿瘤接触均与脑积水、脑膜播散、远处实质复发和降低生存率有关。然而，之前的研究并未在单个患者群体中对这些变量进行综合分析；因此，尚不清楚哪些是这些结果的独立预测因素。
通过对 232 例患者的回顾性队列研究，对手术性脑室进入和 SVZ 接触的脑胶质母细胞瘤进行比较结果分析。
研究的结果包括脑积水、脑膜播散、远处肿瘤复发以及无进展生存期（PFS）和总生存期（OS）。Cox 比例风险回归分析调整了诊断时的年龄、术前卡诺夫斯基表现状态评分、切除范围、替莫唑胺和放疗以及肿瘤分子状态（具体为 IDH1/2 突变和 MGMT 启动子甲基化）。
在 85 例（36.6%）、114 例（49.1%）、19 例（8.2%）、78 例（33.6%）和 59 例（25.4%）患者中分别观察到手术性脑室进入、SVZ 接触的脑胶质母细胞瘤、脑积水、脑膜播散和远处复发。多变量、调整后的分析表明，SVZ 肿瘤接触而非脑室进入与脑积水（风险比[HR]，4.20 [1.13-15.7]，P=0.03）、脑膜播散（HR 1.93 [1.14-3.28]，P=0.01）、PFS（HR 2.10 [1.53-2.88]，P<0.001）和 OS（HR 1.90 [1.35-2.67]，P<0.001）相关。远处复发与这两者均无关。没有统计学意义上注意到这两个变量之间的相互作用。
SVZ 接触脑胶质母细胞瘤与脑积水、脑膜播散和生存率降低独立相关。SVZ 肿瘤接触与手术切除过程中的脑室进入有关，但与这些结果无独立相关性。
