Kucharczyk Michael Jonathan, Parpia Sameer, Whitton Anthony, Greenspoon Jeffrey Noah
Juravinski Cancer Centre, 699 Concession Street, Hamilton, Ontario, Canada (M.J.K.; A.W.; J.N.G.), Ontario Clinical Oncology Group, McMaster University, 771 Concession Street, Hamilton, Ontario, Canada (S.P.).
Neurooncol Pract. 2017 Jun;4(2):120-134. doi: 10.1093/nop/npw021. Epub 2016 Nov 4.
Management of glioblastoma is complicated by pseudoprogression, a radiological phenomenon mimicking progression. This retrospective cohort study investigated the incidence, prognostic implications, and most clinically appropriate definition of pseudoprogression.
Consecutive glioblastoma patients treated at the Juravinski Hospital and Cancer Centre, Hamilton, Ontario between 2004 and 2012 with temozolomide chemoradiotherapy and with contrast-enhanced MRI at standard imaging intervals were included. At each imaging interval, patient responses as per the RECIST (Response Evaluation Criteria in Solid Tumors), MacDonald, and RANO (Response Assessment in Neuro-Oncology) criteria were reported. Based on each set of criteria, subjects were classified as having disease response, stable disease, pseudoprogression, or true progression. The primary outcome was overall survival.
The incidence of pseudoprogression among 130 glioblastoma patients treated with chemoradiotherapy was 15%, 19%, and 23% as defined by RANO, MacDonald, and RECIST criteria, respectively. Using the RANO definition, median survival for patients with pseudoprogression was 13.0 months compared with 12.5 months for patients with stable disease (hazard ratio [HR]=0.70; 95% confidence interval [CI], 0.35-1.42). Similarly, using the MacDonald definition, median survival for the pseudoprogression group was 11.8 months compared with 12.0 months for the stable disease group (HR=0.86; 95% CI, 0.47-1.58). Furthermore, disease response compared with stable disease was also similar using the RANO (HR=0.52; 95% CI, 0.20-1.35) and MacDonald (HR=0.51: 95% CI, 0.20-1.31) definitions.
Of all conventional glioblastoma response criteria, the RANO criteria gave the lowest incidence of pseudoprogression. Regardless of criteria, patients with pseudoprogression did not have statistically significant difference in survival compared with patients with stable disease.
胶质母细胞瘤的治疗因假性进展而变得复杂，假性进展是一种类似疾病进展的放射学现象。这项回顾性队列研究调查了假性进展的发生率、预后影响以及最恰当的临床定义。
纳入2004年至2012年期间在安大略省汉密尔顿市朱拉温斯基医院和癌症中心接受替莫唑胺同步放化疗且按照标准成像间隔进行增强MRI检查的连续性胶质母细胞瘤患者。在每个成像间隔，按照实体瘤疗效评价标准（RECIST）、麦克唐纳标准和神经肿瘤疗效评估（RANO）标准报告患者的反应。根据每组标准，将受试者分类为疾病缓解、疾病稳定、假性进展或真性进展。主要结局为总生存期。
在接受同步放化疗的130例胶质母细胞瘤患者中，按照RANO标准、麦克唐纳标准和RECIST标准定义的假性进展发生率分别为15%、19%和23%。采用RANO定义时，假性进展患者的中位生存期为13.0个月，而疾病稳定患者为12.5个月（风险比[HR]=0.70；95%置信区间[CI]，0.35 - 1.42）。同样，采用麦克唐纳定义时，假性进展组的中位生存期为11.8个月，疾病稳定组为12.0个月（HR=0.86；95% CI，0.47 - 1.58）。此外，采用RANO（HR=0.52；95% CI，0.20 - 1.35）和麦克唐纳（HR=0.51：95% CI，0.20 - 1.31）定义时，疾病缓解与疾病稳定相比也相似。
在所有传统的胶质母细胞瘤反应标准中，RANO标准给出的假性进展发生率最低。无论采用何种标准，假性进展患者与疾病稳定患者在生存期方面无统计学显著差异。
