Department of Neurosurgery, Atkinson Morley Wing, St George's Hospital, London, SW17 0QT, UK.
Clin Neurol Neurosurg. 2020 Jan;188:105568. doi: 10.1016/j.clineuro.2019.105568. Epub 2019 Oct 24.
The role of repeat resection for recurrent glioblastoma multiforme (rGBM) is unclear. This large comparative cohort study assessed overall survival (OS), survival since recurrence (SSR), quality of life, and complications in reoperated versus non-reoperated patients for rGBM.
All patients with rGBM between 2005 and 2015, who were discussed by our institution's multi-disciplinary team, and who either did or did not undergo reoperation, were prospectively followed up with data collected and compared. Survival and prognostic factors were analysed using Kaplan-Meier and Cox regression methods.
312 patients (reoperated, n = 145; non-reoperated, n = 167) were analysed. Median SSR was 10.8 months and 6.9 months in the reoperated and non-reoperated groups respectively (Log-rank test: p = 0.02). Median OS was 24.1 months and 20.4 months in the reoperated and non-reoperated groups, respectively (Log-rank test: p = 0.04). Quality of life as measured by Short Form 36 scores were 59 versus 54 at baseline and 62 versus 51 at four-month follow-up for re-operated and non-reoperated groups, respectively (p < 0.05). Age < 60 years, Karnofsky Performance Status (KPS) ≥ 80, recurrence ≥ 9 months from initial diagnosis, methylguanine methyltransferase (MGMT) promoter methylation, and extent of resection (EOR) > 80 %, each were significant predictors of SSR and OS. Complication rates were 5.5 % and 6.2 % following repeat resection and primary resection, respectively (p > 0.05).
This is the first large prospective comparative cohort study of rGBM and demonstrates that repeat resection confers a small but significant benefit in survival and quality of life over non-operative treatment. Best prognosis is associated with: younger age, KPS ≥ 80, late recurrence, MGMT promoter methylation and EOR > 80 %.
复发性多形性胶质母细胞瘤（rGBM）重复切除的作用尚不清楚。本大型对照队列研究评估了 rGBM 患者中接受和未接受再次手术的患者的总生存期（OS）、复发后生存期（SSR）、生活质量和并发症。
2005 年至 2015 年间，所有经我院多学科团队讨论并接受或未接受再次手术的 rGBM 患者，前瞻性随访并收集数据进行比较。采用 Kaplan-Meier 和 Cox 回归方法分析生存和预后因素。
共分析了 312 例患者（再次手术组 n=145，非再次手术组 n=167）。再次手术组和非再次手术组的 SSR 中位数分别为 10.8 个月和 6.9 个月（对数秩检验：p=0.02）。OS 的中位数分别为 24.1 个月和 20.4 个月（对数秩检验：p=0.04）。SF-36 评分的生活质量分别为再次手术组和非再次手术组的 59 分和 54 分（基线），62 分和 51 分（4 个月随访）（p<0.05）。年龄<60 岁、Karnofsky 表现状态（KPS）≥80、复发距离初始诊断≥9 个月、甲基鸟嘌呤甲基转移酶（MGMT）启动子甲基化和切除程度（EOR）>80%，均为 SSR 和 OS 的显著预测因素。再次切除和初次切除的并发症发生率分别为 5.5%和 6.2%（p>0.05）。
这是首次对 rGBM 进行的大型前瞻性对照队列研究，表明重复切除可使患者的生存和生活质量获得小但有显著意义的改善。最佳预后与年龄较小、KPS≥80、晚期复发、MGMT 启动子甲基化和 EOR>80%相关。
