Departments of1Neurosurgery.
2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and.
J Neurosurg. 2021 Jun 4;136(1):1-8. doi: 10.3171/2020.10.JNS203366. Print 2022 Jan 1.
The authors' goal was to use a multicenter, observational cohort study to determine whether supramarginal resection (SMR) of FLAIR-hyperintense tumor beyond the contrast-enhanced (CE) area influences the overall survival (OS) of patients with isocitrate dehydrogenase-wild-type (IDH-wt) glioblastoma after gross-total resection (GTR).
The medical records of 888 patients aged ≥ 18 years who underwent resection of GBM between January 2011 and December 2017 were reviewed. Volumetric measurements of the CE tumor and surrounding FLAIR-hyperintense tumor were performed, clinical variables were obtained, and associations with OS were analyzed.
In total, 101 patients with newly diagnosed IDH-wt GBM who underwent GTR of the CE tumor met the inclusion criteria. In multivariate analysis, age ≥ 65 years (HR 1.97; 95% CI 1.01-2.56; p < 0.001) and contact with the lateral ventricles (HR 1.59; 95% CI 1.13-1.78; p = 0.025) were associated with shorter OS, but preoperative Karnofsky Performance Status ≥ 70 (HR 0.47; 95% CI 0.27-0.89; p = 0.006), MGMT promotor methylation (HR 0.63; 95% CI 0.52-0.99; p = 0.044), and increased percentage of SMR (HR 0.99; 95% CI 0.98-0.99; p = 0.02) were associated with longer OS. Finally, 20% SMR was the minimum percentage associated with beneficial OS (HR 0.56; 95% CI 0.35-0.89; p = 0.01), but > 60% SMR had no significant influence (HR 0.74; 95% CI 0.45-1.21; p = 0.234).
SMR is associated with improved OS in patients with IDH-wt GBM who undergo GTR of CE tumor. At least 20% SMR of the CE tumor was associated with beneficial OS, but greater than 60% SMR had no significant influence on OS.
作者的目标是通过一项多中心观察性队列研究，确定在 GTR 后，是否对强化 MRI（CE）区域以外的 FLAIR 高信号肿瘤进行边缘性切除（SMR），是否会影响异柠檬酸脱氢酶野生型（IDH-wt）胶质母细胞瘤患者的总生存期（OS）。
回顾了 2011 年 1 月至 2017 年 12 月期间接受 GBM 切除术的 888 名年龄≥18 岁患者的病历。对 CE 肿瘤和周围 FLAIR 高信号肿瘤进行容积测量，获取临床变量，并分析与 OS 的相关性。
共有 101 例新诊断的 IDH-wt GBM 患者接受了 CE 肿瘤的 GTR，符合纳入标准。多变量分析显示，年龄≥65 岁（HR 1.97；95%CI 1.01-2.56；p<0.001）和与侧脑室接触（HR 1.59；95%CI 1.13-1.78；p=0.025）与较短的 OS 相关，但术前 Karnofsky 表现状态≥70（HR 0.47；95%CI 0.27-0.89；p=0.006）、MGMT 启动子甲基化（HR 0.63；95%CI 0.52-0.99；p=0.044）和 SMR 百分比增加（HR 0.99；95%CI 0.98-0.99；p=0.02）与较长的 OS 相关。最后，20%的 SMR 是与 OS 获益相关的最小百分比（HR 0.56；95%CI 0.35-0.89；p=0.01），但>60%的 SMR 无显著影响（HR 0.74；95%CI 0.45-1.21；p=0.234）。
在接受 CE 肿瘤 GTR 的 IDH-wt GBM 患者中，SMR 与改善 OS 相关。CE 肿瘤至少 20%的 SMR 与 OS 获益相关，但大于 60%的 SMR 对 OS 无显著影响。
