低级别胶质瘤的手术切除范围：基于分子亚型的差异影响。
Extent of Surgical Resection in Lower-Grade Gliomas: Differential Impact Based on Molecular Subtype.
机构信息
From the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
From the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.).
出版信息
AJNR Am J Neuroradiol. 2019 Jul;40(7):1149-1155. doi: 10.3174/ajnr.A6102. Epub 2019 Jun 27.
BACKGROUND AND PURPOSE
Diffuse lower-grade gliomas are classified into prognostically meaningful molecular subtypes. We aimed to determine the impact of surgical resection on overall survival in lower-grade glioma molecular subtypes.
MATERIALS AND METHODS
For 172 patients with lower-grade gliomas (World Health Organization grade II or III), pre- and postsurgical glioma volumes were determined using a semiautomated segmentation software based on FLAIR or T2-weighted MR imaging sequences. The association of pre- and postsurgical glioma volume and the percentage of glioma resection with overall survival was determined for the entire cohort and separately for lower-grade glioma molecular subtypes based on () and 1p/19q status, after adjustment for age, sex, World Health Organization grade, chemotherapy administration, and radiation therapy administration.
RESULTS
For the entire cohort, postsurgical glioma volume (hazard ratio, 1.80; 95% CI, 1.18-2.75; = .006) and the percentage of resection (hazard ratio, 3.22; 95% CI, 1.79-5.82; < .001) were associated with overall survival. For -mutant 1p/19q-codeleted oligodendrogliomas, the percentage of resection (hazard ratio, 6.69; 95% CI, 1.57-28.46; = .01) was associated with overall survival. For -mutant 1p/19q-noncodeleted astrocytomas, presurgical glioma volume (hazard ratio, 3.20; 95% CI, 1.22-8.39; = .018), postsurgical glioma volume (hazard ratio, 2.33; 95% CI, 1.32-4.12; = .004), and percentage of resection (hazard ratio, 4.34; 95% CI, 1.74-10.81; = .002) were associated with overall survival. For -wild-type lower-grade gliomas, pre-/postsurgical glioma volume and percentage of resection were not associated with overall survival.
CONCLUSIONS
The extent of surgical resection has a differential survival impact in patients with lower-grade gliomas based on their molecular subtype. -mutant lower-grade gliomas benefit from a greater extent of surgical resection, with the strongest impact observed for -mutant 1p/19q-noncodeleted astrocytomas.
背景与目的
弥漫性低级别胶质瘤可分为具有预后意义的分子亚型。本研究旨在确定手术切除对低级别胶质瘤分子亚型患者总生存期的影响。
材料与方法
对 172 例低级别胶质瘤患者（世界卫生组织[WHO]分级 II 或 III 级）进行研究，采用基于 FLAIR 或 T2 加权 MR 成像序列的半自动分割软件确定术前和术后胶质瘤体积。在调整年龄、性别、WHO 分级、化疗和放疗后，根据 1p/19q 状态和 （）对整个队列以及基于 1p/19q 状态和 （）的低级别胶质瘤分子亚型分别进行术前和术后胶质瘤体积以及胶质瘤切除程度与总生存期的相关性分析。
结果
在整个队列中，术后胶质瘤体积（风险比[HR]，1.80；95%置信区间[CI]，1.18-2.75； =.006）和切除程度（HR，3.22；95%CI，1.79-5.82； <.001）与总生存期相关。对于 突变 1p/19q 缺失型少突胶质细胞瘤，切除程度（HR，6.69；95%CI，1.57-28.46； =.01）与总生存期相关。对于 突变 1p/19q 未缺失型星形细胞瘤，术前胶质瘤体积（HR，3.20；95%CI，1.22-8.39； =.018）、术后胶质瘤体积（HR，2.33；95%CI，1.32-4.12； =.004）和切除程度（HR，4.34；95%CI，1.74-10.81； =.002）与总生存期相关。对于野生型 低级别胶质瘤，术前/术后胶质瘤体积和切除程度与总生存期无关。
结论
基于低级别胶质瘤的分子亚型，手术切除的范围对患者的生存有不同的影响。 突变型低级别胶质瘤患者从更大程度的手术切除中获益，而 突变 1p/19q 未缺失型星形细胞瘤的获益最大。
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