新诊断的 II 级星形细胞瘤和少突胶质细胞瘤的术中磁共振成像和其他因素对手术结果的影响：一项多中心研究。

Impact of Intraoperative Magnetic Resonance Imaging and Other Factors on Surgical Outcomes for Newly Diagnosed Grade II Astrocytomas and Oligodendrogliomas: A Multicenter Study.

机构信息

Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri.

Department of Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts.

出版信息

Neurosurgery. 2020 Dec 15;88(1):63-73. doi: 10.1093/neuros/nyaa320.

DOI:10.1093/neuros/nyaa320

Abstract

BACKGROUND

Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative magnetic resonance imaging (iMRI) in the resection of grade II gliomas.

OBJECTIVE

To assess the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly diagnosed grade II astrocytomas and oligodendrogliomas.

METHODS

Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS and PFS.

RESULTS

A total of 232 resections (112 astrocytomas and 120 oligodendrogliomas) were analyzed. Oligodendrogliomas had longer OS (P < .001) and PFS (P = .01) than astrocytomas. Multivariate analyses demonstrated improved OS for gross total resection (GTR) vs subtotal resection (STR; P = .006, hazard ratio [HR]: .23) and near total resection (NTR; P = .02, HR: .64). GTR vs STR (P = .02, HR: .54), GTR vs NTR (P = .04, HR: .49), and iMRI use (P = .02, HR: .54) were associated with longer PFS. Frontal (P = .048, HR: 2.11) and occipital/parietal (P = .003, HR: 3.59) locations were associated with shorter PFS (vs temporal). Kaplan-Meier analyses showed longer OS with increasing extent of surgical resection (EOR) (P = .03) and 1p/19q gene deletions (P = .02). PFS improved with increasing EOR (P = .01), GTR vs NTR (P = .02), and resections above STR (P = .04). Factors influencing adjuvant treatment (35.3% of patients) included age (P = .002, odds ratio [OR]: 1.04) and EOR (P = .003, OR: .39) but not glioma subtype or location. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these instances.

CONCLUSION

EOR is a major determinant of OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.

摘要

背景

很少有研究使用大型多机构患者队列来研究术中磁共振成像（iMRI）在 II 级胶质瘤切除中的作用。

目的

评估 iMRI 及其他因素对新诊断的 II 级星形细胞瘤和少突胶质细胞瘤的总生存期（OS）和无进展生存期（PFS）的影响。

方法

对多中心数据库进行回顾性分析，评估患者、治疗和肿瘤相关因素对 OS 和 PFS 的影响。

结果

共分析了 232 例切除术（112 例星形细胞瘤和 120 例少突胶质细胞瘤）。少突胶质细胞瘤的 OS（P<0.001）和 PFS（P=0.01）均长于星形细胞瘤。多变量分析显示，与次全切除术（STR；P=0.006，风险比[HR]：0.23）和近全切除术（NTR；P=0.02，HR：0.64）相比，大体全切除（GTR）的 OS 改善。GTR 与 STR（P=0.02，HR：0.54）、GTR 与 NTR（P=0.04，HR：0.49）和 iMRI 应用（P=0.02，HR：0.54）与较长的 PFS 相关。额部（P=0.048，HR：2.11）和枕部/顶叶（P=0.003，HR：3.59）部位与较短的 PFS 相关（与颞部相比）。Kaplan-Meier 分析显示，随着手术切除范围（EOR）的增加（P=0.03）和 1p/19q 基因缺失（P=0.02），OS 时间延长。PFS 随着 EOR 的增加（P=0.01）、GTR 与 NTR（P=0.02）和高于 STR 的切除术（P=0.04）而改善。影响辅助治疗的因素（患者的 35.3%）包括年龄（P=0.002，优势比[OR]：1.04）和 EOR（P=0.003，OR：0.39），但与胶质瘤亚型或部位无关。在 159 例 iMRI 病例中有 105 例（66%）进行了额外的肿瘤切除术，其中 54.5%获得了 GTR。