Yan Shan Shan, James Melissa L, Kerstens Peter, de Lambert Megan, Robinson Bridget A, Yi Ma
Department of Radiation Oncology, Christchurch Hospital, Christchurch, New Zealand.
Department of Radiation Oncology, Wellington Hospital, Wellington, New Zealand.
J Med Imaging Radiat Oncol. 2019 Oct;63(5):665-673. doi: 10.1111/1754-9485.12944. Epub 2019 Aug 28.
High-grade glioma (HGG) is a devastating illness. Our study aimed to investigate outcomes for patients with HGG treated in Christchurch focussing particularly on those diagnosed with glioblastoma mulitforme (GBM); compare GBM survival with international standards; examine factors associated with better prognosis; and assess the involvement of various allied health disciplines.
A 10-year retrospective study of patients who were diagnosed and treated for HGG at Christchurch Hospital. Kaplan-Meier method was used to estimate survival. Predefined multivariate analysis was performed to investigate potential prognostic and predictive factors.
A total of 363 patients were diagnosed with HGG at a median age of 64 years with a 5-year overall survival of 6.1%. Patients with grade IV tumours had a poorer outcome than grade III patients (P = 0.0002, log-rank test). Eighty-two per cent of patients had a surgical resection or biopsy of the tumour. For those patients with GBM, gross tumour resection followed by radical chemoradiation was associated with better survival compared with needle biopsy (HR = 1.93, P = 0.018); increasing age was negatively associated with survival (HR = 1.02 per additional age year, P = 0.037); however, waiting time between neurosurgery and radiation did not affect survival. Six per cent of patients received formal psychological input.
Our survival outcomes were comparable with internationally published series. More research is required to improve survival in HGG, including molecular guided treatment, and better define treatment paradigms, such as for the elderly and frail.
高级别胶质瘤（HGG）是一种毁灭性疾病。我们的研究旨在调查在克赖斯特彻奇接受治疗的HGG患者的预后情况，尤其关注那些被诊断为多形性胶质母细胞瘤（GBM）的患者；将GBM的生存率与国际标准进行比较；研究与更好预后相关的因素；并评估各联合健康学科的参与情况。
对在克赖斯特彻奇医院被诊断并接受HGG治疗的患者进行为期10年的回顾性研究。采用Kaplan-Meier方法估计生存率。进行预定义的多变量分析以研究潜在的预后和预测因素。
共有363例患者被诊断为HGG，中位年龄为64岁，5年总生存率为6.1%。IV级肿瘤患者的预后比III级患者差（P = 0.0002，对数秩检验）。82%的患者对肿瘤进行了手术切除或活检。对于那些GBM患者，与针吸活检相比，肿瘤大体切除后进行根治性放化疗与更好的生存率相关（HR = 1.93，P = 0.018）；年龄增加与生存率呈负相关（每增加一岁HR = 1.02，P = 0.037）；然而，神经外科手术和放疗之间的等待时间并不影响生存率。6%的患者接受了正式的心理干预。
我们的生存结果与国际发表的系列研究相当。需要更多研究来提高HGG的生存率，包括分子导向治疗，并更好地确定治疗模式，如针对老年人和体弱者的治疗模式。
