Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
Neurosurg Rev. 2021 Jun;44(3):1401-1409. doi: 10.1007/s10143-020-01328-w. Epub 2020 Jun 4.
The impact of midline shift (MLS) on long-term survival and progression in glioblastoma (GBM) is unknown. The objective of this study was to analyze the influence of mass effect on survival and progression with consideration of the patient demographics, tumor morphology, operative techniques, molecular pathology, and postoperative treatment. One hundred ninety-eight patients with GBM were analyzed retrospectively. Both MLS groups (< or ≥ 10 mm) were compared with regard to survival, progression-free survival (PFS), and postoperative course of Karnofsky Performance Status (KPS). A two-sided Fisher exact test showed no statistically significant differences in the confounders between the low- and high-MLS groups. The median survival was 18.0 months (95% confidence interval (CI) = 15.3-20.7) in the low-MLS group (n = 173) and 9.0 months (95% CI = 4.8-13.2) in the high-MLS group (n = 25) (p = 0.045). In the high-MLS group, 59.1% (13/22) with an initially high MLS had a KPS of less than 70% after 3 months, whereas 20.5% of the low-MLS group had a KPS of less than 70% (p < 0.001). Binary logistic regression analysis including the O-6-methylguanine-DNA methyltransferase (MGMT) status, extent of resection, baseline KPS, and MIB-I index showed low MLS as the only predictor for survival at 12 months (p = 0.046, odds ratio (OR) = 2.70, 95% CI = 1.0-7.2). Median PFS was 6.0 months in the high-MLS group and 9.0 months in the low-MLS group (log-rank test; p = 0.08). An initial midline shift of 10 mm or greater seems to be an imaging characteristic that independently predicts the survival in glioblastoma.
中线移位（MLS）对胶质母细胞瘤（GBM）的长期生存和进展的影响尚不清楚。本研究的目的是分析在考虑患者人口统计学、肿瘤形态、手术技术、分子病理学和术后治疗的情况下，肿块效应对生存和进展的影响。对 198 例 GBM 患者进行回顾性分析。比较 MLS 两组（<10mm 和≥10mm）的生存、无进展生存（PFS）和术后卡诺夫斯基表现状态（KPS）。双侧 Fisher 确切检验显示低 MLS 组和高 MLS 组之间的混杂因素无统计学差异。低 MLS 组（n=173）的中位生存时间为 18.0 个月（95%置信区间（CI）=15.3-20.7），高 MLS 组（n=25）的中位生存时间为 9.0 个月（95%CI=4.8-13.2）（p=0.045）。在高 MLS 组中，22 例初始 MLS 较高的患者中，59.1%（13/22）在 3 个月后 KPS 小于 70%，而低 MLS 组中，20.5%（13/22）KPS 小于 70%（p<0.001）。包括 O-6-甲基鸟嘌呤-DNA 甲基转移酶（MGMT）状态、切除范围、基线 KPS 和 MIB-I 指数在内的二项逻辑回归分析显示，低 MLS 是 12 个月时生存的唯一预测因素（p=0.046，优势比（OR）=2.70，95%CI=1.0-7.2）。高 MLS 组的中位 PFS 为 6.0 个月，低 MLS 组为 9.0 个月（对数秩检验；p=0.08）。初始中线移位 10mm 或更大似乎是独立预测胶质母细胞瘤生存的影像学特征。
