Fyllingen Even Hovig, Bø Lars Eirik, Reinertsen Ingerid, Jakola Asgeir Store, Sagberg Lisa Millgård, Berntsen Erik Magnus, Salvesen Øyvind, Solheim Ole
Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas Gate 1, 7006, Trondheim, Norway.
Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Acta Neurochir (Wien). 2021 Jul;163(7):1895-1905. doi: 10.1007/s00701-021-04802-6. Epub 2021 Mar 20.
Previous studies on the effect of tumor location on overall survival in glioblastoma have found conflicting results. Based on statistical maps, we sought to explore the effect of tumor location on overall survival in a population-based cohort of patients with glioblastoma and IDH wild-type astrocytoma WHO grade II-III with radiological necrosis.
Patients were divided into three groups based on overall survival: < 6 months, 6-24 months, and > 24 months. Statistical maps exploring differences in tumor location between these three groups were calculated from pre-treatment magnetic resonance imaging scans. Based on the results, multivariable Cox regression analyses were performed to explore the possible independent effect of centrally located tumors compared to known prognostic factors by use of distance from center of the third ventricle to contrast-enhancing tumor border in centimeters as a continuous variable.
A total of 215 patients were included in the statistical maps. Central tumor location (corpus callosum, basal ganglia) was associated with overall survival < 6 months. There was also a reduced overall survival in patients with tumors in the left temporal lobe pole. Tumors in the dorsomedial right temporal lobe and the white matter region involving the left anterior paracentral gyrus/dorsal supplementary motor area/medial precentral gyrus were associated with overall survival > 24 months. Increased distance from center of the third ventricle to contrast-enhancing tumor border was a positive prognostic factor for survival in elderly patients, but less so in younger patients.
Central tumor location was associated with worse prognosis. Distance from center of the third ventricle to contrast-enhancing tumor border may be a pragmatic prognostic factor in elderly patients.
先前关于胶质母细胞瘤中肿瘤位置对总生存期影响的研究结果相互矛盾。基于统计图谱，我们试图在一个基于人群的胶质母细胞瘤患者队列以及伴有放射性坏死的WHO II - III级异柠檬酸脱氢酶（IDH）野生型星形细胞瘤患者中，探讨肿瘤位置对总生存期的影响。
根据总生存期将患者分为三组：<6个月、6 - 24个月和>24个月。通过治疗前的磁共振成像扫描计算出探索这三组之间肿瘤位置差异的统计图谱。基于这些结果，进行多变量Cox回归分析，以厘米为单位，将从第三脑室中心到强化肿瘤边界的距离作为连续变量，探讨与已知预后因素相比，中心部位肿瘤可能存在的独立影响。
共有215例患者纳入统计图谱分析。肿瘤位于中心部位（胼胝体、基底神经节）与总生存期<6个月相关。左颞叶极部有肿瘤的患者总生存期也缩短。右颞叶背内侧以及涉及左中央旁前回/背侧辅助运动区/中央前回内侧的白质区域的肿瘤与总生存期>24个月相关。从第三脑室中心到强化肿瘤边界的距离增加是老年患者生存的一个阳性预后因素，但在年轻患者中作用较小。
肿瘤位于中心部位与较差的预后相关。从第三脑室中心到强化肿瘤边界的距离可能是老年患者一个实用的预后因素。
