Neville Iuri Santana, Dos Santos Alexandra Gomes, Almeida Cesar Cimonari, Abaurre Leonardo Bilich, Wayhs Samia Yasin, Feher Olavo, Teixeira Manoel Jacobsen, Lepski Guilherme
Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas.
Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, Brazil.
Surg Neurol Int. 2021 Feb 3;12:42. doi: 10.25259/SNI_538_2020. eCollection 2021.
The current standard treatment for glioblastoma (GBM) is maximal safe surgical resection followed by radiation and chemotherapy. Unfortunately, the disease will invariably recur even with the best treatment. Although the literature suggests some advantages in reoperating patients harboring GBM, controversy remains. Here, we asked whether reoperation is an efficacious treatment strategy for GBM, and under which circumstances, it confers a better prognosis.
We retrospectively reviewed 286 consecutive cases of newly diagnosed GBM in a single university hospital from 2008 to 2015. We evaluated clinical and epidemiological parameters possibly influencing overall survival (OS) by multivariate Cox regression analysis. OS was calculated using the Kaplan-Meier method in patients submitted to one or two surgical procedures. Finally, the survival curves were fitted with the Weibull model, and survival rates at 6, 12, and 24 months were estimated.
The reoperated group survived significantly longer ( = 63, OS = 20.0 ± 2.3 vs. 11.4 ± 1.0 months, < 0.0001). Second, the multivariate analysis revealed an association between survival and number of surgeries, initial Karnofsky Performance Status, and age (all < 0.001). Survival estimates according to the Weibull regression model revealed higher survival probabilities for reoperation compared with one operation at 6 months (83.74 ± 3.42 vs. 63.56 ± 3.59, respectively), 12 months (64.00 ± 4.85 vs. 37.53 ± 3.52), and 24 months (32.53 ± 4.78 vs. 12.02 ± 2.36).
Our data support the indication of reoperation for GBM, especially for younger patients with good functional status. Under these circumstances, survival can be doubled at 12 and 24 months.
胶质母细胞瘤（GBM）目前的标准治疗方法是最大程度的安全手术切除，随后进行放疗和化疗。不幸的是，即使采用最佳治疗，该疾病仍会不可避免地复发。尽管文献表明对患有GBM的患者再次手术有一些优势，但争议仍然存在。在此，我们探讨再次手术是否是GBM的有效治疗策略，以及在何种情况下，它能带来更好的预后。
我们回顾性分析了2008年至2015年在一家大学医院连续收治的286例新诊断的GBM病例。通过多因素Cox回归分析评估可能影响总生存期（OS）的临床和流行病学参数。采用Kaplan-Meier法计算接受一次或两次手术患者的OS。最后，用Weibull模型拟合生存曲线，并估计6个月、12个月和24个月时的生存率。
再次手术组存活时间显著更长（=63，OS=20.0±2.3个月对11.4±1.0个月，<0.0001）。其次，多因素分析显示生存与手术次数、初始卡氏功能状态和年龄之间存在关联（均<0.001）。根据Weibull回归模型的生存估计显示，与一次手术相比，再次手术在6个月时的生存概率更高（分别为83.74±3.42对63.56±3.59），12个月时（64.00±4.85对37.53±3.52），以及24个月时（32.53±4.78对12.02±2.36）。
我们的数据支持对GBM进行再次手术，特别是对于功能状态良好的年轻患者。在这些情况下，12个月和24个月时的生存期可延长一倍。
