Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA.
Department of Neurology, University of Miami School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
J Neurooncol. 2020 May;148(1):155-164. doi: 10.1007/s11060-020-03508-6. Epub 2020 May 11.
Diffuse tumor invasion in multifocal/multicentric GBM (mGBM) often foreshadows poor survival outcome. The correlation between extent of resection in gliomas and patient outcome is well described. The objective of this study was to assess the effect of gross total resection compared to biopsy for mGBM on patient overall survival and progression free survival.
Thirty-four patients with mGBM received either biopsy or resection of their largest enhancing lesion from 2011 to 2019. Relevant demographic, peri-operative, and radiographic data were collected. Tumor burden and extent of resection was assessed through measurement of pre-operative and post-operative contrast-enhancing volume. An adjusted Kaplan-Meier survival analysis was conducted using inverse probability of treatment weighting (IPTW) to account for the covariates of age, number of lesions, satellite tumor volume, total pre-operative tumor volume, degree of spread, and location.
Thirty-four patients were identified with sixteen (47.1%) and eighteen (52.9%) patients receiving resection and biopsy respectively. Patients receiving resection exhibited greater median overall survival but not progression free survival compared to biopsy on IPTW analysis (p = 0.026, p = 0.411). Greater than or equal to 85% extent of resection was significantly associated with increased median overall survival (p = 0.016).
Overall, our study suggests that resection of the largest contrast-enhancing lesion may provide a survival benefit. Our volumetric analysis suggests that a greater degree of resection results in improved survival. Employing IPTW analysis, we sought to control for selection bias in our retrospective analysis. Thus, aggressive surgical treatment of mGBM may offer improved outcomes. Further clinical trials are needed.
多灶/多中心胶质母细胞瘤（mGBM）的弥漫性肿瘤侵袭常常预示着预后不良。在胶质瘤中，切除范围与患者预后之间的相关性已有很好的描述。本研究的目的是评估与 mGBM 的活检相比，最大限度地切除肿瘤对患者总生存和无进展生存的影响。
2011 年至 2019 年期间，34 例 mGBM 患者接受了最大强化病变的活检或切除术。收集了相关的人口统计学、围手术期和影像学数据。通过测量术前和术后对比增强体积来评估肿瘤负担和切除范围。采用逆概率治疗加权（IPTW）进行调整的 Kaplan-Meier 生存分析，以考虑年龄、病变数量、卫星肿瘤体积、总术前肿瘤体积、扩散程度和位置等协变量。
确定了 34 例患者，其中 16 例（47.1%）和 18 例（52.9%）患者分别接受了切除术和活检。在 IPTW 分析中，接受切除术的患者的中位总生存时间更长，但无进展生存时间无差异（p=0.026，p=0.411）。大于或等于 85%的切除范围与中位总生存时间的增加显著相关（p=0.016）。
总的来说，我们的研究表明，切除最大强化病变可能提供生存获益。我们的体积分析表明，更大程度的切除可改善生存。通过采用 IPTW 分析，我们试图控制回顾性分析中的选择偏差。因此，积极的手术治疗 mGBM 可能会带来更好的结果。需要进一步的临床试验。
