1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
2Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
J Neurosurg. 2020 May 8;134(5):1357-1367. doi: 10.3171/2020.2.JNS192767. Print 2021 May 1.
Genomic analysis in neurooncology has underscored the importance of understanding the patterns of survival in different molecular subtypes within gliomas and their responses to treatment. In particular, diffuse gliomas are now principally characterized by their mutation status (IDH1 and 1p/19q codeletion), yet there remains a paucity of information regarding the prognostic value of molecular markers and extent of resection (EOR) on survival. Furthermore, given the modern emphasis on molecular rather than histological diagnosis, it is important to examine the effect of maximal resection on survival in all gliomas with 1p/q19 codeletions, as these will now be classified as oligodendrogliomas under the new WHO guidelines. The objectives of the present study were twofold: 1) to assess the association between EOR and survival for patients with oligodendrogliomas in the National Cancer Database (NCDB), which includes information on mutation status, and 2) to demonstrate the same effect for all patients with 1p/19q codeleted gliomas in the NCDB.
The NCDB was queried for all cases of oligodendroglioma between 2004 and 2014, with follow-up dates through 2016. The authors found 2514 cases of histologically confirmed oligodendrogliomas for the final analysis of the effect of EOR on survival. Upon further query, 1067 1p/19q-codeleted tumors were identified in the NCDB. Patients who received subtotal resection (STR) or gross-total resection (GTR) were compared to those who received no tumor debulking surgery. Univariable and multivariable analyses of both overall survival and cause-specific survival were performed.
EOR was associated with increased overall survival for both histologically confirmed oligodendrogliomas and all 1p/19q-codeleted-defined tumors (p < 0.001 and p = 0.002, respectively). Tumor grade, location, and size covaried predictably with EOR. When evaluating tumors by each classification system for predictors of overall survival, facility setting, age, comorbidity index, grade, location, chemotherapy, and radiation therapy were all shown to be significantly associated with overall survival. STR and GTR were independent predictors of improved survival in historically classified oligodendrogliomas (HR 0.83, p = 0.18; HR 0.69, p = 0.01, respectively) and in 1p/19q-codeleted tumors (HR 0.49, p < 0.01; HR 0.43, p < 0.01, respectively).
By using the NCDB, the authors have demonstrated a side-by-side comparison of the survival benefits of greater EOR in 1p/19q-codeleted gliomas.
神经肿瘤学的基因组分析强调了了解不同分子亚型在胶质瘤中的生存模式及其对治疗反应的重要性。特别是，弥漫性神经胶质瘤现在主要以其突变状态（IDH1 和 1p/19q 缺失）为特征，但对于分子标志物和切除范围（EOR）对生存的预后价值仍知之甚少。此外，鉴于现代强调分子而非组织学诊断，重要的是要检查在所有具有 1p/q19 缺失的神经胶质瘤中，最大限度切除对生存的影响，因为根据新的世界卫生组织（WHO）指南，这些神经胶质瘤现在将被归类为少突胶质细胞瘤。本研究的目的有两个：1）评估国家癌症数据库（NCDB）中 EOR 与少突胶质细胞瘤患者生存之间的关联，该数据库包括突变状态信息，2）证明 NCDB 中所有 1p/19q 缺失型神经胶质瘤患者的相同效果。
对 2004 年至 2014 年间 NCDB 中所有经组织学证实的少突胶质细胞瘤病例进行了查询，并随访至 2016 年。作者发现了 2514 例经组织学证实的少突胶质细胞瘤，用于最终分析 EOR 对生存的影响。进一步查询发现，NCDB 中有 1067 例 1p/19q 缺失型肿瘤。比较接受次全切除术（STR）或大体全切除术（GTR）的患者与未接受肿瘤减瘤手术的患者。对总生存率和特定原因生存率进行了单变量和多变量分析。
EOR 与组织学证实的少突胶质细胞瘤和所有 1p/19q 缺失定义的肿瘤的总生存率增加相关（p <0.001 和 p = 0.002）。肿瘤分级、位置和大小可预测性地与 EOR 相关。在评估每个分类系统的肿瘤总体生存率预测因素时，设施设置、年龄、合并症指数、分级、位置、化疗和放疗均与总体生存率显著相关。STR 和 GTR 是历史分类的少突胶质细胞瘤（HR 0.83，p = 0.18；HR 0.69，p = 0.01）和 1p/19q 缺失型肿瘤（HR 0.49，p <0.01；HR 0.43，p <0.01）的独立生存预测因素。
通过使用 NCDB，作者在 1p/19q 缺失型胶质瘤中证明了 EOR 更大的生存获益的并排比较。
