胶质母细胞瘤的超全切除：少即是多？

Supratotal Resection of Glioblastoma: Is Less More?

作者信息

Altieri Roberto, Melcarne Antonio, Soffietti Riccardo, Rudá Roberta, Franchino Federica, Pellerino Alessia, La Rocca Giuseppe, Sabatino Giovanni, Olivi Alessandro, Ducati Alessandro, Zeppa Pietro, Tardivo Valentina, Mantovani Cristina, Chiovatero Ilaria, Martini Stefania, Dolce Pasquale, Savastano Riccardo, Lanotte Michele Maria, Zenga Francesco, Garbossa Diego

机构信息

Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy.

Neuro-Oncological Unit, Department of Neuroscience, University of Turin, Turin, Italy.

出版信息

Surg Technol Int. 2019 Nov 10;35:432-440.

PMID:31373379

Abstract

BACKGROUND

A relationship between the extent of resection (EOR) and survival has been demonstrated in patients with glioblastomas (GBMs). However, despite gross total resection (GTR) of the enhancing nodule (EN), GBMs usually relapse, generally near the surgical cavity.

OBJECTIVE

The aim of this study was to determine the prognostic role of FLAIR resection of GBMs by analyzing pre- and post-operative MRIs to estimate the EOR of EN, FLAIR-hyperintense regions and total tumor volume (TTV).

METHODS

Radiologic and clinical outcomes were analyzed retrospectively. Pre- and post-operative EN volume, pre- and postoperative FLAIR volume (POFV), and pre- and postoperative TTV were analyzed. EOR was then calculated for each component. Time-dependent ROC curves and cut-off values for pre- and post-operative volumes and EOR were calculated. A Kaplan-Meier analysis with the log-rank test and Cox regression analysis were then used to analyze progression-free survival (PFS) and overall survival (OS).

RESULTS

We did not find any correlation between EOR of FLAIR-altered regions and patient survival. On the other hand, there were statistically significant relationships between the prognosis and both a preoperative EN volume less than 31.35 cm3 (p=0.032) and a postoperative EN volume less than 0.57 cm3 (p=0.015). Moreover, an EOR of EN greater than 96% was significantly associated with the prognosis (p=0.0051 for OS and p=0.022 for PFS).

CONCLUSION

Our retrospective, multi-center study suggests that survival in patients with GBM is not affected by the extent of resection of FLAIR-hyperintense areas.

摘要

背景

胶质母细胞瘤（GBM）患者的切除范围（EOR）与生存率之间的关系已得到证实。然而，尽管对增强结节（EN）进行了大体全切除（GTR），GBM通常仍会复发，且一般在手术腔附近。

目的

本研究的目的是通过分析术前和术后的磁共振成像（MRI）来估计EN、液体衰减反转恢复序列（FLAIR）高信号区域和肿瘤总体积（TTV）的EOR，以确定GBM的FLAIR切除的预后作用。

方法

对放射学和临床结果进行回顾性分析。分析术前和术后的EN体积、术前和术后的FLAIR体积（POFV）以及术前和术后的TTV。然后计算每个成分的EOR。计算术前和术后体积及EOR的时间依赖性ROC曲线和临界值。然后使用带有对数秩检验的Kaplan-Meier分析和Cox回归分析来分析无进展生存期（PFS）和总生存期（OS）。

结果

我们未发现FLAIR改变区域的EOR与患者生存率之间存在任何相关性。另一方面，预后与术前EN体积小于31.35 cm³（p = 0.032）和术后EN体积小于0.57 cm³（p = 0.015）均存在统计学上的显著关系。此外，EN的EOR大于96%与预后显著相关（OS的p = 0.0051，PFS的 p = 0.022）。