1Brain Tumor Center & Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.
2Department of Neurology & Neurosurgery, University Medical Center Utrecht, The Netherlands.
J Neurosurg. 2020 Apr 3;134(3):1091-1101. doi: 10.3171/2020.1.JNS193049. Print 2021 Mar 1.
Decisions in glioblastoma surgery are often guided by presumed eloquence of the tumor location. The authors introduce the "expected residual tumor volume" (eRV) and the "expected resectability index" (eRI) based on previous decisions aggregated in resection probability maps. The diagnostic accuracy of eRV and eRI to predict biopsy decisions, resectability, functional outcome, and survival was determined.
Consecutive patients with first-time glioblastoma surgery in 2012-2013 were included from 12 hospitals. The eRV was calculated from the preoperative MR images of each patient using a resection probability map, and the eRI was derived from the tumor volume. As reference, Sawaya's tumor location eloquence grades (EGs) were classified. Resectability was measured as observed extent of resection (EOR) and residual volume, and functional outcome as change in Karnofsky Performance Scale score. Receiver operating characteristic curves and multivariable logistic regression were applied.
Of 915 patients, 674 (74%) underwent a resection with a median EOR of 97%, functional improvement in 71 (8%), functional decline in 78 (9%), and median survival of 12.8 months. The eRI and eRV identified biopsies and EORs of at least 80%, 90%, or 98% better than EG. The eRV and eRI predicted observed residual volumes under 10, 5, and 1 ml better than EG. The eRV, eRI, and EG had low diagnostic accuracy for functional outcome changes. Higher eRV and lower eRI were strongly associated with shorter survival, independent of known prognostic factors.
The eRV and eRI predict biopsy decisions, resectability, and survival better than eloquence grading and may be useful preoperative indices to support surgical decisions.
胶质母细胞瘤手术中的决策通常基于肿瘤位置的假定语言能力。作者引入了“预期残余肿瘤体积”（eRV）和“预期可切除性指数”（eRI），这些指标基于在切除概率图中汇总的先前决策。确定 eRV 和 eRI 预测活检决策、可切除性、功能结果和生存率的诊断准确性。
从 2012 年至 2013 年的 12 家医院中连续纳入首次接受胶质母细胞瘤手术的患者。使用切除概率图从每位患者的术前磁共振图像中计算 eRV，并从肿瘤体积中推导出 eRI。作为参考，对 Sawaya 的肿瘤位置语言能力等级（EG）进行分类。可切除性测量为观察到的切除范围（EOR）和残余体积，功能结果测量为卡诺夫斯基表现量表评分的变化。应用了受试者工作特征曲线和多变量逻辑回归。
915 例患者中，674 例（74%）接受了切除术，中位 EOR 为 97%，71 例（8%）功能改善，78 例（9%）功能下降，中位生存期为 12.8 个月。eRI 和 eRV 比 EG 更好地确定了至少 80%、90%或 98%的活检和 EOR。eRV 和 eRI 比 EG 更好地预测了观察到的残余体积小于 10、5 和 1ml。eRV、eRI 和 EG 对功能结果变化的诊断准确性较低。较高的 eRV 和较低的 eRI 与较短的生存期密切相关，与已知的预后因素无关。
eRV 和 eRI 比语言能力分级更好地预测活检决策、可切除性和生存率，并且可能是支持手术决策的有用术前指标。
