Department of Neurosurgery, Ghent University Hospital, Gent, Belgium.
Department of Neurosurgery, Ghent University Hospital, Gent, Belgium.
Surg Oncol. 2020 Dec;35:515-519. doi: 10.1016/j.suronc.2020.10.016. Epub 2020 Nov 1.
Background Isocitrate dehydrogenase (IDH)-wildtype glioblastoma patients with O-methylguanine-DNA-methyltransferase (MGMT)-unmethylated tumors have the worst outcome of all glioblastoma patients. The overall survival (OS) benefit of partial resection of glioblastoma compared to biopsy only remains controversial specifically in relation to molecular factors. In this report, we analyzed the effect of incomplete resection on OS compared to biopsy only in a cohort of IDH-wildtype glioblastoma patients who were uniformly treated with temozolomide-based chemoradiotherapy (TMZ-CR) after surgery. Material & Methods A retrospective study was conducted including only glioblastoma patients who were treated with TMZ-CR after surgery from two centers. Surgical groups were defined as biopsy only, partial resection (PR) or gross total resection depending on the presence of contrast-enhancing tumor on postoperative imaging. IDH-mutation was determined using next generation sequencing technique and MGMT-methylation was analyzed with semi-quantitative methylation-specific polymerase chain reaction. Next to descriptive statistics, univariate and multivariate survival analyses were performed using Kaplan-Meier estimates and Cox regression models. Results In total, 159 patients were included. 37 patients underwent biopsy only and 73 partial resections. 99 patients (62.3%) harbored unmethylated tumors. Median OS for the whole patient group was 13.4 months. In the subgroup of patients with unmethylated tumors, PR yielded a median OS of 12.2 months vs 7.6 months for biopsy patients (P = 0.003). PR proved an independent beneficial prognostic factor in multivariate Cox regression model, together with age, Karnofsky Performance Score and MGMT-methylation. Conclusion In IDH-wildtype glioblastoma patients with MGMT-unmethylated tumors, treated with chemoradiotherapy after surgery, PR yields a significant OS benefit compared to biopsy.
异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤患者伴 O-甲基鸟嘌呤-DNA-甲基转移酶（MGMT）未甲基化肿瘤的总生存（OS）结局是所有胶质母细胞瘤患者中最差的。与单纯活检相比，手术部分切除胶质母细胞瘤的 OS 获益在分子因素方面仍然存在争议。在本报告中，我们分析了 IDH 野生型胶质母细胞瘤患者在手术后均接受替莫唑胺为基础的放化疗（TMZ-CR）治疗的情况下，与单纯活检相比，不完全切除对 OS 的影响。
这项回顾性研究仅纳入了在两个中心接受 TMZ-CR 治疗的 IDH 野生型胶质母细胞瘤患者。根据术后影像学上是否存在增强肿瘤，手术组定义为单纯活检、部分切除（PR）或大体全切除。使用下一代测序技术确定 IDH 突变，使用半定量甲基化特异性聚合酶链反应分析 MGMT 甲基化。除了描述性统计外，还使用 Kaplan-Meier 估计和 Cox 回归模型进行了单变量和多变量生存分析。
共纳入 159 例患者。37 例患者仅行活检，73 例行部分切除。99 例（62.3%）患者存在未甲基化肿瘤。全组患者的中位 OS 为 13.4 个月。在未甲基化肿瘤亚组中，PR 的中位 OS 为 12.2 个月，而活检组为 7.6 个月（P=0.003）。PR 在多变量 Cox 回归模型中是一个独立的有益预后因素，与年龄、Karnofsky 表现评分和 MGMT 甲基化一起。
在接受手术后放化疗的 IDH 野生型、MGMT 未甲基化肿瘤的胶质母细胞瘤患者中，与单纯活检相比，PR 可显著改善 OS。
