Neuro-Oncology Unit, Medical Oncology Department, Instituto de Oncología Ángel H. Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina.
Neuro-Oncology Unit, Surgical Oncology Department, Instituto de Oncología Ángel H. Roffo, Universidad de Buenos Aires, Buenos Aires, Argentina.
PLoS One. 2021 Apr 2;16(4):e0249486. doi: 10.1371/journal.pone.0249486. eCollection 2021.
High-Grade Gliomas (HGG) are the most frequent brain tumor in adults. The gold standard of clinical care recommends beginning chemoradiation within 6 weeks of surgery. Disparities in access to healthcare in Argentina are notorious, often leading to treatment delays. We conducted this retrospective study to evaluate if time to chemoradiation after surgery is correlated with progression-free survival (PFS). Our study included clinical cases with a histological diagnosis of Glioblastoma (GBM), Anaplastic Astrocytoma (AA) or High-Grade Glioma (HGG) in patients over 18 years of age from 2014 to 2020. We collected data on clinical presentation, type of resection, time to surgery, time to chemoradiation, location within the Buenos Aires Metropolitan Area (BAMA) and type of health insurance. We found 63 patients that fit our inclusion criteria, including 26 (41.3%) females and 37 (58.7%) males. Their median age was 54 years old (19-86). Maximal safe resection was achieved in 49.2% (n = 31) of the patients, incomplete resection in 34.9% (n = 22) and the other 15.9% (n = 10) received a biopsy, but no resection. The type of health care insurance was almost evenly divided, with 55.6% (n = 35) of the patients having public vs. 44.4% (n = 28) having private health insurance. Median time to chemoradiation after surgery was 8 (CI 6.68-9.9) weeks for the global population. When we ordered the patients PFS by time to chemoradiation we found that there was a statistically significant effect of time to chemoradiation on patient PFS. Patients had a PFS of 10 months (p = 0.014) (CI 6.89-13.10) when they received chemoradiation <5 weeks vs a PFS of 7 months (CI 4.93-9.06) when they received chemoradiation between 5 to 8 weeks and a PFS of 4 months (CI 3.76-4.26 HR 2.18 p = 0.006) when they received chemoradiation >8 weeks after surgery. Also, our univariate and multivariate analysis found that temporal lobe location (p = 0.03), GMB histology (p = 0.02) and biopsy as surgical intervention (p = 0.02) all had a statistically significant effect on patient PFS. Thus, time to chemoradiation is an important factor in patient PFS. Our data show that although an increase in HGG severity contributes to a decrease in patient PFS, there is also a large effect of time to chemoradiation. Our results suggest that we can improve patient PFS by making access to healthcare in Buenos Aires more equitable by reducing the average time to chemoradiation following tumor resection.
高级别胶质瘤（HGG）是成年人中最常见的脑肿瘤。临床护理的金标准建议在手术后 6 周内开始放化疗。阿根廷的医疗保健获取方面存在明显的差异，这往往导致治疗延误。我们进行了这项回顾性研究，以评估手术后放化疗的时间是否与无进展生存期（PFS）相关。
我们的研究包括了 2014 年至 2020 年期间在年龄超过 18 岁的患者中，组织学诊断为胶质母细胞瘤（GBM）、间变性星形细胞瘤（AA）或高级别胶质瘤（HGG）的临床病例。我们收集了临床症状、切除类型、手术时间、放化疗时间、布宜诺斯艾利斯大都市区（BAMA）内的位置和健康保险类型的数据。我们发现 63 名符合纳入标准的患者，包括 26 名（41.3%）女性和 37 名（58.7%）男性。他们的中位年龄为 54 岁（19-86 岁）。最大安全切除在 49.2%（n=31）的患者中实现，34.9%（n=22）的患者切除不完全，另外 15.9%（n=10）接受了活检但未进行切除。医疗保险的类型几乎平分秋色，有 55.6%（n=35）的患者拥有公共医疗保险，而 44.4%（n=28）的患者拥有私人医疗保险。全球人群术后放化疗的中位时间为 8（CI 6.68-9.9）周。当我们根据放化疗时间对患者的 PFS 进行排序时，我们发现放化疗时间对患者 PFS 有统计学显著影响。接受放化疗<5 周的患者 PFS 为 10 个月（p=0.014）（CI 6.89-13.10），接受放化疗 5-8 周的患者 PFS 为 7 个月（CI 4.93-9.06），接受放化疗>8 周的患者 PFS 为 4 个月（CI 3.76-4.26 HR 2.18 p=0.006）。此外，我们的单变量和多变量分析发现，颞叶位置（p=0.03）、GBM 组织学（p=0.02）和活检作为手术干预（p=0.02）都对患者的 PFS 有统计学显著影响。
因此，放化疗时间是患者 PFS 的一个重要因素。我们的数据表明，尽管 HGG 严重程度的增加导致患者 PFS 下降，但放化疗时间也有很大的影响。我们的结果表明，通过减少肿瘤切除后接受放化疗的平均时间，使布宜诺斯艾利斯的医疗保健获取更加公平，我们可以提高患者的 PFS。
