Department of Neurosurgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA.
Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurosurg Rev. 2021 Jun;44(3):1259-1271. doi: 10.1007/s10143-020-01331-1. Epub 2020 Jun 13.
The inevitable recurrence of glioblastoma (GBM) results in patients often undergoing multiple resections with questionable benefit to overall survival (OS).
To systematically review and analyze prior studies examining the potential added benefit of repeat resection (RR) in recurrent GBM.
We performed a PRISMA-compliant systematic review of literature published between 1969 to 2019 involving patients undergoing RR at GBM recurrence.
The search yielded 3994 non-duplicate citations. Final abstraction included 43 articles, with 2 level II and 41 level III studies. The earliest paper we included was published in 1987 [1], and 35 identified papers (81.4%) were published within the last 10 years. The survival data of 9236 patients (55% male) were analyzed, with a median age of 56; 3726 patients underwent RR. In 31 studies with a comparable single-surgery-only cohort, 20 articles reported a statistically significant increase in OS with RR, 7 reported nonsignificant trends toward increased OS with RR, and 4 reported no significant increase in OS with RR. Twenty-two articles with multivariate analyses of Karnofsky performance scores and 17 articles with extent-of-resection reported these as significant prognostic factors of OS. In 26 studies, median OS among all patients was 17.85 months inclusive of median OS following RR totaling 9.6 months. Notably, in 10 studies with data on subsequent progressions (2+ recurrences), 6 studies reported significant increases in OS with subsequent repeat resection (sRR) compared to those not undergoing sRR.
Recurrent GBM presents a treatment challenge. There appears to be an OS benefit for RR upon first recurrence as well as sRR. Such findings warrant further investigation of the potential benefits of continued surgical intervention after subsequent progressions of GBM.
胶质母细胞瘤（GBM）的不可避免复发导致患者经常需要多次切除，其对总生存（OS）的获益存在争议。
系统回顾和分析既往研究，以评估在复发性 GBM 中重复切除（RR）的潜在获益。
我们对 1969 年至 2019 年间发表的涉及 GBM 复发后 RR 的文献进行了符合 PRISMA 原则的系统回顾。
搜索共得到 3994 篇非重复引用。最终纳入 43 篇文章，其中 2 篇为 II 级研究，41 篇为 III 级研究。我们纳入的最早的一篇文献发表于 1987 年[1]，35 篇识别文献（81.4%）发表于最近 10 年。对 9236 例患者（55%为男性）的生存数据进行了分析，患者的中位年龄为 56 岁，3726 例患者接受了 RR。在 31 项具有可比的单次手术仅队列的研究中，有 20 篇报道 RR 可显著提高 OS，7 篇报道 RR 有增加 OS 的趋势但无统计学意义，4 篇报道 RR 不能显著提高 OS。22 篇有卡氏功能状态评分的多变量分析和 17 篇有切除范围的报道，这些都是 OS 的显著预后因素。在 26 项研究中，所有患者的中位 OS 为 17.85 个月，包括 RR 后的中位 OS 为 9.6 个月。值得注意的是，在 10 项有后续进展（2+复发）数据的研究中，有 6 项研究报道与未行 sRR 的患者相比，sRR 可显著提高 OS。
复发性 GBM 是治疗难题。初次复发时 RR 和 sRR 似乎都能提高 OS。这些发现需要进一步研究在 GBM 后续进展后继续手术干预的潜在获益。
