Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany.
Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany.
Neurosurgery. 2020 Jan 1;86(1):E64-E74. doi: 10.1093/neuros/nyz397.
In diffuse WHO grade II gliomas (LGG), the extent of resection (EOR) required to achieve significant survival benefits remains elusive.
To evaluate the association of residual volume (RV) and EOR with progression-free survival (PFS) or overall survival (OS) in LGG in a retrospective, multicenter series by the German study group of intraoperative MRI (GeSGIM).
Consecutive cases were retrospectively assessed from 5 centers. Tumors were volumetrically quantified before and after surgery, and clinical data were analyzed, including IDH mutations and neurologic deficits. Kaplan-Meier estimates, accelerated failure time models (AFT), and multivariate Cox regression models were calculated to identify determinants of survival.
A total of 140 cases were analyzed. Gross total resection (GTR) was associated with significantly longer PFS compared to any incomplete resection (P = .009). A significant survival disadvantage was evident even for small (>0-5 ml) residuals and increased for moderate (>5-20 ml) and large remnants (>20 ml) P = .001). Accordingly, PFS increased continuously for 20% incremental steps of EOR (P < .001). AFT models supported the notion of a continuous association of RV and EOR with PFS. Multivariate Cox regression models confirmed RV (P = .01) and EOR (P = .005) as continuous prognosticators of PFS. Univariate analysis showed significant associations of RV and EOR with OS.
Our data support the hypothesis of a continuous relationship of RV and EOR with survival for LGG with superiority seen for GTR. Hence, GTR should be achieved whenever safely feasible, and resections should be maximized whenever tumor has to be left behind to spare function.
在弥漫性世界卫生组织（WHO）二级胶质瘤（LGG）中，仍难以确定实现显著生存获益所需的切除程度（EOR）。
通过德国术中磁共振成像（GeSGIM）研究组的一项回顾性多中心系列研究，评估残余体积（RV）和 EOR 与 LGG 无进展生存期（PFS）或总生存期（OS）的相关性。
连续评估来自 5 个中心的病例。肿瘤在术前和术后进行容积量化，并分析包括 IDH 突变和神经功能缺损在内的临床数据。通过 Kaplan-Meier 估计、加速失效时间模型（AFT）和多变量 Cox 回归模型计算来确定生存的决定因素。
共分析了 140 例病例。与任何不完全切除相比，完全切除（GTR）与更长的 PFS 显著相关（P =.009）。即使对于较小的（>0-5 ml）残余物，也存在明显的生存劣势，对于中等大小的（>5-20 ml）和较大的（>20 ml）残余物，劣势更为明显（P =.001）。因此，EOR 每增加 20%，PFS 就会持续增加（P <.001）。AFT 模型支持 RV 和 EOR 与 PFS 之间存在连续关联的观点。多变量 Cox 回归模型证实 RV（P =.01）和 EOR（P =.005）是 PFS 的连续预后因素。单变量分析显示 RV 和 EOR 与 OS 显著相关。
我们的数据支持 RV 和 EOR 与 LGG 生存之间存在连续关系的假设，GTR 具有优势。因此，只要安全可行，应尽可能实现 GTR，并且应在需要保留肿瘤以保护功能时最大化切除范围。
