Sacko Oumar, Benouaich-Amiel Alexandra, Brandicourt Pierre, Niaré Mahamadou, Charni Saloua, Cavandoli Clarissa, Brauge David, Catalaa Isabelle, Brenner Adam, Moyal Elizabeth Cohen-Jonathan, Roux Franck-Emmanuel
Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
Université Paul-Sabatier, Toulouse, France.
Asian J Neurosurg. 2021 Feb 23;16(1):1-7. doi: 10.4103/ajns.AJNS_180_20. eCollection 2021 Jan-Mar.
The purpose of this study was to investigate the possible benefit of repeat surgery on overall survival for patients with recurrent glioblastoma multiforme (GBM).
We performed a retrospective analysis of data from patients who presented with recurrent GBM over a 5-year period ( = 157), comparing baseline characteristics and survival for patients who had at least 1 new tumor resection followed by chemotherapy (reoperation group, = 59) and those who received medical treatment only (no-reoperation group, = 98) for recurrence.
The baseline characteristics of the two groups differed in terms of WHO performance status (better in the reoperation group), mean age (60 years in the reoperation group vs. 65 years in the no-reoperation group), mean interval to recurrence (3 months later in the reoperation group than in the no-reoperation group) and more gross total resections in the reoperation group. Nevertheless, the patients in the reoperation group had a higher rate [32.8%] of sensorimotor deficits than those of the no-reoperation group [14.2]. There was no significant difference in sex; tumor localization, side, or extent; MGMT status; MIB-1 labeling index; or Karnofsky Performance Status [KPS] score. After adjustment for age, the WHO performance status, interval of recurrence, and extent of resection at the first operation, multivariate analysis showed that median survival was significantly better in the reoperation group than in the no-reoperation group (22.9 vs. 14.61 months, < 0.05). After a total of 69 repeat operations in 59 patients (10 had 2 repeat surgeries), we noted 13 temporary and 20 permanent adverse postoperative events, yielding a permanent complication rate of 28.99% (20/69). There was also a statistically significant ( = 0.029, Student's -test) decrease in the mean KPS score after reoperation (mean preoperative KPS score of 89.34 vs. mean postoperative score of 84.91).
Our retrospective study suggests that repeat surgery may be beneficial for patients with GBM recurrence who have good functional status (WHO performance status 0 and 1), although the potential benefits must be weighed against the risk of permanent complications, which occurred in almost 30% of the patients who underwent repeat resection in this series.
本研究旨在探讨再次手术对复发性多形性胶质母细胞瘤（GBM）患者总生存期的潜在益处。
我们对5年间出现复发性GBM的患者数据进行了回顾性分析（n = 157），比较了至少接受1次新的肿瘤切除并随后进行化疗的患者（再次手术组，n = 59）和仅接受药物治疗的复发患者（未再次手术组，n = 98）的基线特征和生存期。
两组的基线特征在以下方面存在差异：世界卫生组织（WHO）功能状态（再次手术组更好）、平均年龄（再次手术组为60岁，未再次手术组为65岁）、复发的平均间隔时间（再次手术组比未再次手术组晚3个月）以及再次手术组有更多的大体全切。然而，再次手术组患者的感觉运动功能障碍发生率[32.8%]高于未再次手术组[14.2%]。在性别、肿瘤定位、侧别或范围、O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）状态、MIB-1标记指数或卡氏功能状态评分（KPS）方面无显著差异。在对年龄、WHO功能状态、复发间隔时间和首次手术切除范围进行调整后，多因素分析显示再次手术组的中位生存期显著优于未再次手术组（22.9个月对14.61个月，P < 0.05）。在59例患者中总共进行了69次再次手术（10例进行了2次再次手术），我们记录了13例临时和20例永久性术后不良事件，永久性并发症发生率为28.99%（20/69）。再次手术后平均KPS评分也有统计学显著下降（P = 0.029，Student's t检验）（术前平均KPS评分为89.34，术后平均评分为84.91）。
我们的回顾性研究表明，再次手术可能对功能状态良好（WHO功能状态为0和1）的GBM复发患者有益，尽管必须将潜在益处与永久性并发症风险相权衡，在本系列中接受再次切除的患者中近30%发生了永久性并发症。
