低级别胶质瘤全切除范围与无进展生存期、恶性转化及总生存期的相关性

Association of supratotal resection with progression-free survival, malignant transformation, and overall survival in lower-grade gliomas.

作者信息

Rossi Marco, Gay Lorenzo, Ambrogi Federico, Conti Nibali Marco, Sciortino Tommaso, Puglisi Guglielmo, Leonetti Antonella, Mocellini Cristina, Caroli Manuela, Cordera Susanna, Simonelli Matteo, Pessina Federico, Navarria Piera, Pace Andrea, Soffietti Riccardo, Rudà Roberta, Riva Marco, Bello Lorenzo

机构信息

Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.

IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy.

出版信息

Neuro Oncol. 2021 May 5;23(5):812-826. doi: 10.1093/neuonc/noaa225.

DOI:10.1093/neuonc/noaa225

PMID:33049063

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8099476/

Abstract

BACKGROUND

Supratotal resection is advocated in lower-grade gliomas (LGGs) based on theoretical advantages but with limited verification of functional risk and data on oncological outcomes. We assessed the association of supratotal resection in molecularly defined LGGs with oncological outcomes.

METHODS

Included were 460 presumptive LGGs; 404 resected; 347 were LGGs, 319 isocitrate dehydrogenase (IDH)-mutated, 28 wildtype. All patients had clinical, imaging, and molecular data. Resection aimed at supratotal resection without any patient or tumor a priori selection. The association of extent of resection (EOR), categorized on volumetric fluid attenuated inversion recovery images as residual tumor volume, along with postsurgical management with progression-free survival (PFS), malignant (M)PFS, and overall survival (OS) assessed by univariate, multivariate, and propensity score analysis. The study mainly focused on IDH-mutated LGGs, the "typical LGGs."

RESULTS

Median follow-up was 6.8 years (interquartile range, 5-8). Out of 319 IDH-mutated LGGs, 190 (59.6%) progressed, median PFS: 4.7 years (95% CI: 4-5.3). Total and supratotal resection obtained in 39% and 35% of patients with IDH1-mutated tumors. In IDH-mutated tumors, most patients in the partial/subtotal group progressed, 82.4% in total, only 6 (5.4%) in supratotal. Median PFS was 29 months (95% CI: 25-36) in subtotal, 46 months (95% CI: 38-48) in total, while at 92 months, PFS in supratotal was 94.0%. There was no association with molecular subtypes and grade. At random forest analysis, PFS strongly associated with EOR, radiotherapy, and previous treatment. In the propensity score analysis, EOR associated with PFS (hazard ratio, 0.03; 95% CI: 0.01-0.13). MPFS occurred in 32.1% of subtotal total groups; 1 event in supratotal. EOR, grade III, previous treatment correlated to MPFS. At random forest analysis, OS associated with EOR as well.

CONCLUSIONS

Supratotal resection strongly associated with PFS, MPFS, and OS in LGGs, regardless of molecular subtypes and grade, right from the beginning of clinical presentation.

摘要

背景

基于理论优势，低级别胶质瘤（LGG）提倡进行超全切除，但功能风险验证有限，且肿瘤学结局的数据也有限。我们评估了分子定义的LGG中超全切除与肿瘤学结局之间的关联。

方法

纳入460例疑似LGG；404例接受了切除手术；347例为LGG，其中319例异柠檬酸脱氢酶（IDH）突变，28例野生型。所有患者均有临床、影像和分子数据。切除目标是超全切除，无任何患者或肿瘤的先验选择。根据容积性液体衰减反转恢复图像将切除范围（EOR）分类为残余肿瘤体积，并结合术后管理，通过单因素、多因素和倾向评分分析评估无进展生存期（PFS）、恶性（M）PFS和总生存期（OS）。该研究主要聚焦于IDH突变的LGG，即“典型LGG”。

结果

中位随访时间为6.8年（四分位间距，5 - 8年）。在319例IDH突变的LGG中，190例（59.6%）进展，中位PFS为4.7年（95%CI：4 - 5.3年）。IDH1突变肿瘤患者中，39%实现了全切除，35%实现了超全切除。在IDH突变肿瘤中，部分/次全切除组的大多数患者进展，全切除组为82.4%，超全切除组仅6例（5.4%）。次全切除组的中位PFS为29个月（95%CI：25 - 36个月），全切除组为46个月（95%CI：38 - 48个月），而超全切除组在92个月时的PFS为94.0%。与分子亚型和分级无关。在随机森林分析中，PFS与EOR、放疗和既往治疗密切相关。在倾向评分分析中，EOR与PFS相关（风险比，0.03；95%CI：0.01 - 0.13）。次全/全切除组中32.1%发生了MPFS；超全切除组1例。EOR、III级、既往治疗与MPFS相关。在随机森林分析中，OS也与EOR相关。