Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Surgery and Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Clin Neurol Neurosurg. 2020 Apr;191:105712. doi: 10.1016/j.clineuro.2020.105712. Epub 2020 Feb 3.
The isocitrate dehydrogenase (IDH) 1 wild-type glioblastoma (GBM) is a major population of GBM that should be of concern in terms of the efficacy of using Temozolomide (TMZ) in adjuvant treatment. This study aimed to compare the effectiveness of TMZ with radiotherapy (RT) and RT alone in patients with IDH1wild-type GBM using a propensity score matching (PSM) approach.
Newly-diagnosed GBM patients were retrospectively analyzed. The clinical variables were collected from a hospital database. Multivariable analysis and propensity score matching (PSM) were used for adjusting the differences in characteristics among patients. The effect of TMZ on the survival of patients with GBM was evaluated by time-to-event analysis based on the multivariable model and PSM.
One hundred and sixty-two patients were included in the unmatched analysis. Overall median survival time was 11 months (95 % CI 9.3-12.6). In the multivariable model, TMZ and RT were associated with significantly longer survival compared with RT alone (Hazard ratio [HR] 0.64, 95 %CI 0.43-0.93). After PSM, each of the 55 patients was assigned to TMZ with RT and RT alone groups. The overall median survival time of matched data was 12.0 months (95 %CI = 10.0-13.9). Additionally, the HR of TMZ with RT was 0.67 (95 %CI 0.46-0.99) in the PSM method.
The present study revealed that the effect of TMZ with RT in IDH1 wild-type GBM patients had advantages in terms of survival by using multivariable analysis and PS approaches. In real-world settings, confounders should be explored and controlled prior to statistical analysis. Also, an economic evaluation of the specific subgroups should be conducted in the future.
异柠檬酸脱氢酶 1 野生型胶质母细胞瘤（GBM）是 GBM 的主要人群，在替莫唑胺（TMZ）辅助治疗中的疗效方面应引起关注。本研究旨在通过倾向评分匹配（PSM）方法比较 TMZ 联合放疗（RT）与单纯 RT 治疗 IDH1 野生型 GBM 的疗效。
回顾性分析新诊断的 GBM 患者。临床变量从医院数据库中收集。多变量分析和倾向评分匹配（PSM）用于调整患者特征之间的差异。基于多变量模型和 PSM，采用时间事件分析评估 TMZ 对 GBM 患者生存的影响。
162 例患者纳入非匹配分析。总体中位生存时间为 11 个月（95%CI9.3-12.6）。在多变量模型中，TMZ 和 RT 与 RT 单药治疗相比，生存时间明显延长（风险比[HR]0.64，95%CI0.43-0.93）。PSM 后，每组 55 例患者分别被分配到 TMZ 联合 RT 和 RT 单药治疗组。匹配数据的总体中位生存时间为 12.0 个月（95%CI=10.0-13.9）。此外，PSM 法中 TMZ 联合 RT 的 HR 为 0.67（95%CI0.46-0.99）。
本研究通过多变量分析和 PSM 方法表明，在 IDH1 野生型 GBM 患者中，TMZ 联合 RT 的治疗效果在生存方面具有优势。在实际情况下，在进行统计分析之前，应探索和控制混杂因素。此外，未来应针对特定亚组进行经济评估。
