Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Neurosurgical Institute of Fudan University, Shanghai, China.
Neurosurgery. 2021 May 13;88(6):1136-1144. doi: 10.1093/neuros/nyab052.
While maximizing extent of resection (EOR) is associated with longer survival in lower-grade glioma (LGG) patients, the number of cases remains insufficient in determining a EOR threshold to elucidate the clinical benefits, especially in IDH-wild-type LGG patients.
To identify the effects of EOR on the survival outcomes of IDH-wild-type LGG patients.
IDH-wild-type LGG patients were retrospectively reviewed. The effect of EOR and other predictor variables on overall survival (OS) and progression-free survival (PFS) was analyzed using Cox regression models and the Kaplan-Meier method.
A total of 94 patients (median OS: 48.9 mo; median follow-up: 30.6 mo) were included in this study. In the multivariable Cox regression analysis, postoperative residual volume was associated with prolonged OS (HR = 2.238; 95% confidence interval [CI], 1.130-4.435; P = .021) and PFS (HR = 2.075; 95% CI, 1.113-3.869; P = .022). Thresholds at a minimum EOR of 97.0% or a maximum residue of 3.0 cm3 were necessary to impact OS positively. For the telomerase reverse transcriptase (TERT)p-wild-type group, such an association was absent. Significant differences in survival existed between the TERTp-wild-type and mutant patients who underwent relatively incomplete resections (residual ≥2.0 cm3 + TERTp wild type: median OS of 62.6 mo [95% CI: 39.7-85.5 mo]; residual ≥2.0 cm3 + TERTp mutant: median OS of 20.0 mo [95% CI:14.6-25.4 mo]).
Our results support the core role of maximal safe resection in the treatment of IDH-wild-type LGGs, especially for IDH-wild-type + TERTp-mutant LGGs. Importantly, the survival benefits of surgery could only be elucidated at a high EOR cut-off point.
最大限度地切除肿瘤（EOR）与低级别胶质瘤（LGG）患者的生存时间延长相关，但由于病例数量不足，无法确定 EOR 阈值以阐明其临床获益，尤其是在 IDH 野生型 LGG 患者中。
确定 EOR 对 IDH 野生型 LGG 患者生存结局的影响。
回顾性分析 IDH 野生型 LGG 患者。使用 Cox 回归模型和 Kaplan-Meier 方法分析 EOR 及其他预测变量对总生存期（OS）和无进展生存期（PFS）的影响。
共纳入 94 例患者（中位 OS：48.9 个月；中位随访时间：30.6 个月）。多变量 Cox 回归分析显示，术后残余肿瘤体积与延长 OS（HR=2.238；95%置信区间 [CI]，1.130-4.435；P=0.021）和 PFS（HR=2.075；95%CI，1.113-3.869；P=0.022）相关。EOR 最小为 97.0%或最大残余物为 3.0cm3 时，可对 OS 产生积极影响。对于端粒酶逆转录酶（TERT）p 野生型组，这种相关性不存在。接受相对不完全切除（残余物≥2.0cm3+TERTp 野生型：中位 OS 62.6 个月[95%CI：39.7-85.5 个月]；残余物≥2.0cm3+TERTp 突变型：中位 OS 20.0 个月[95%CI：14.6-25.4 个月]）的 TERTp 野生型和突变型患者的生存存在显著差异。
我们的研究结果支持最大限度安全切除在 IDH 野生型 LGG 治疗中的核心作用，特别是对于 IDH 野生型+TERTp 突变型 LGG。重要的是，仅在高 EOR 截止点才能阐明手术的生存获益。
