Mao Hua, Li Xianguo, Mao Weipu
Department of Neurosurgery, Jingzhou Central Hospital, The Second Clinical Medical College of Yangtze University, Jingzhou, Hubei 434020, P.R. China.
Department of General Practice, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China.
Oncol Lett. 2020 Jun;19(6):3761-3774. doi: 10.3892/ol.2020.11514. Epub 2020 Apr 6.
The present study aimed to investigate the association between surgical methods and survival outcomes in patients with astrocytoma. Patients diagnosed with astrocytoma between January 2004 and December 2015 were identified using the Surveillance, Epidemiology and End Results database. Kaplan-Meier curves and Cox regression were used to analyze the effects of surgical methods on overall survival (OS) and cancer-specific survival (CSS). Among 42,224 eligible patients with astrocytoma, 11,427 (27.1%) patients did not receive surgery, 7,661 (18.1%) received excisional biopsy (EB), 5,520 (13.1%) received a subtotal resection (STR), 6,037 (14.3%) received a gross resection (GR), 5,314 (12.6%) received a partial resection (PR) and 6,265 (14.8%) received a gross total resection (GTR). Patients who underwent GR had the longest survival time (17.00 months). However, over time, the proportion of patients who underwent STR or GR increased, whereas the proportion of patients who did not undergo surgery, PR or GTR decreased. Furthermore, surgical method was an independent prognostic factor for OS and CSS for the patients with astrocytoma. Multivariate Cox regression showed that GTR was associated with the more favorable OS [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.77-0.83; P<0.001] and CSS (HR, 0.80; 95% CI, 0.77-0.83; P<0.001) times compared with EB. Moreover, similar results were observed in subgroup analyses based on summary stage and grade. In the present study, it was demonstrated that GTR was one of the effective surgical methods for improved OS and CSS time in patients with astrocytoma. However, among the American astrocytoma population, the proportion of patients who underwent GTR decreased. It is necessary to further advocate for the efficacy of GTR.
本研究旨在探讨星形细胞瘤患者手术方法与生存结局之间的关联。利用监测、流行病学和最终结果数据库确定了2004年1月至2015年12月期间诊断为星形细胞瘤的患者。采用Kaplan-Meier曲线和Cox回归分析手术方法对总生存期（OS）和癌症特异性生存期（CSS）的影响。在42224例符合条件的星形细胞瘤患者中，11427例（27.1%）患者未接受手术，7661例（18.1%）接受切除活检（EB），5520例（13.1%）接受次全切除（STR），6037例（14.3%）接受大体切除（GR），5314例（12.6%）接受部分切除（PR），6265例（14.8%）接受全切除（GTR）。接受GR的患者生存时间最长（17.00个月）。然而，随着时间的推移，接受STR或GR的患者比例增加，而未接受手术、PR或GTR的患者比例下降。此外，手术方法是星形细胞瘤患者OS和CSS的独立预后因素。多变量Cox回归显示，与EB相比，GTR与更有利的OS（风险比[HR]，0.80；95%置信区间[CI]，0.77-0.83；P<0.001）和CSS（HR，0.80；95%CI，0.77-0.83；P<0.001）相关。此外，在基于总结分期和分级的亚组分析中也观察到了类似结果。在本研究中，证明GTR是改善星形细胞瘤患者OS和CSS时间的有效手术方法之一。然而，在美国星形细胞瘤人群中，接受GTR的患者比例下降。有必要进一步倡导GTR的疗效。
