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成人丘脑胶质瘤的外科治疗和生存结果:单中心 8 年经验。

Surgical treatment and survival outcome of patients with adult thalamic glioma: a single institution experience of 8 years.

机构信息

Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.

West China Glioma Centre, West China Hospital, Sichuan University, Chengdu, 610041, China.

出版信息

J Neurooncol. 2020 Apr;147(2):377-386. doi: 10.1007/s11060-020-03430-x. Epub 2020 Mar 10.

Abstract

PURPOSE

Given the rarity in the population with adult thalamic gliomas (ATGs), comprehensive characteristics, treatments and survival outcome are not well characterized. This study was conducted to investigate the comprehensive characteristic and treatment of ATGs and identify the prognostic factors associated with overall survival (OS).

METHODS

A retrospective analysis of newly diagnosed ATGs who underwent surgical resection consecutively was conducted. Survival analysis of OS was performed by Kaplan-Meier analysis. Cox proportional hazard model was used to investigate the possible prognostic factors associated with OS.

RESULTS

A total of 102 patients with ATG were enrolled in this study. The median age was 41 years (range 18-68 years). There were 56 (54.9%) males. Sixty-two patients (60.8%) had glioblastoma (GBM). Among these patients, 46 patients (45.1%) had GTR/NTR, 50 patients (49.0%) had STR and 6 patients (5.9%) had PR. Postoperatively, 71.6% of these patients received adjuvant therapy. The median OS was 13.6 months (range 1 week-75 months). COX regression analysis revealed that ATG patients with longer duration of symptoms (p = 0.024), better pre-KPS (p = 0.045), maximal resection (p = 0.013), or lower tumor grade (p = 0.002) had longer OS, and these predictors are considered as independent prognostic factors. Survival analysis showed that ATGs with GTR/NTR plus chemoradiotherapy had significant OS advantage compared with other treatment regimens.

CONCLUSIONS

This study comprehensively summarized the characteristics, treatments and survival outcomes of ATGs in the largest sample size. Maximal surgical resection can bring survival benefit. Combined-modality therapy regimen of GTR/NTR plus chemoradiotherapy may be better beneficial for OS than other regimens.

摘要

目的

鉴于成人丘脑胶质瘤(ATG)在人群中的罕见性,其全面特征、治疗方法和生存结果尚未得到很好的描述。本研究旨在调查 ATG 的综合特征和治疗方法,并确定与总生存(OS)相关的预后因素。

方法

对连续行手术切除的新诊断为 ATG 的患者进行回顾性分析。通过 Kaplan-Meier 分析进行 OS 的生存分析。Cox 比例风险模型用于研究与 OS 相关的可能预后因素。

结果

本研究共纳入 102 例 ATG 患者。中位年龄为 41 岁(范围 18-68 岁)。男性 56 例(54.9%)。62 例(60.8%)患者为胶质母细胞瘤(GBM)。其中,46 例(45.1%)行最大限度肿瘤切除术(GTR/NTR),50 例(49.0%)行次最大限度肿瘤切除术(STR),6 例(5.9%)行部分肿瘤切除术(PR)。术后,71.6%的患者接受辅助治疗。中位 OS 为 13.6 个月(范围 1 周-75 个月)。COX 回归分析显示,症状持续时间较长(p=0.024)、术前 KPS 较好(p=0.045)、最大限度肿瘤切除术(p=0.013)或肿瘤分级较低(p=0.002)的 ATG 患者 OS 更长,这些预测因素被认为是独立的预后因素。生存分析显示,与其他治疗方案相比,GTR/NTR 联合放化疗的 ATG 患者具有显著的 OS 优势。

结论

本研究在最大样本量中全面总结了 ATG 的特征、治疗方法和生存结果。最大限度的手术切除可以带来生存获益。GTR/NTR 联合放化疗的联合治疗方案可能比其他方案更有利于 OS。

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