Ghaffari-Rafi Arash, Ghaffari-Rafi Shadeh, Leon-Rojas Jose
John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.
Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
Asian J Neurosurg. 2021 Feb 23;16(1):14-23. doi: 10.4103/ajns.AJNS_186_20. eCollection 2021 Jan-Mar.
OBJECTIVE/INTRODUCTION: Although a critical chemotherapeutic, temozolomide's optimal regimen for 2016 World Health Organization (WHO) Grade II gliomas remains elusive, hence there is utility in not only cataloging survival outcomes of Grade II glioma subtypes against the background of temozolomide regimens, but also quantifying differences in progression-free survival (PFS) and overall survival (OS).
A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trails was conducted by using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Handbook of Systemic Reviews of Interventions.
Each molecular subtype of WHO Grade II glioma had a different temozolomide regimen identified as optimal in prolonging PFS and OS. For PFS, with temozolomide, the 25, 50, and 75 percentiles, were as follows (in months), respectively-A-wt II: 6.90, 12.95, and 19.95; A-mt II: 34.45, 36.01, and 39.60; OD II: 37.90, 46.00, and 55.03 ( = 0.016). For OS, the first quartile (25%), median (50%), third quartile (75%), were respectively identified (in months-A-wt II: 21.6 (median; = 1); A-mt II: 60.6, 85.2, and 109.8; OD II: 86.1, 96.2, and 106.3 ( = 0.37).
For each tumor molecular subtype, a different temozolomide regimen was identified as optimal for prolonging PFS and OS. Furthermore, regardless of temozolomide regimen, A-wt II had a significantly shorter PFS than A-mt II and OD-II. Overall, the data can provide useful prognostic insight to patients when making critical treatment decisions. Moreover, by cataloging and assessing survival outcomes per temozolomide regimen, such may facilitate future clinical trial design.
目的/引言：虽然替莫唑胺是一种关键的化疗药物，但2016年世界卫生组织（WHO）II级胶质瘤的最佳治疗方案仍不明确，因此，不仅有必要梳理替莫唑胺治疗方案背景下II级胶质瘤亚型的生存结果，而且要量化无进展生存期（PFS）和总生存期（OS）的差异。
采用系统评价和Meta分析的首选报告项目以及Cochrane干预措施系统评价手册，对MEDLINE、Embase和Cochrane对照试验中央注册库进行了系统评价。
WHO II级胶质瘤的每种分子亚型都有不同的替莫唑胺治疗方案被确定为延长PFS和OS的最佳方案。对于PFS，使用替莫唑胺时，第25、50和75百分位数分别如下（以月为单位）——A-wt II：6.90、12.95和19.95；A-mt II：34.45、36.01和39.60；OD II：37.90、46.00和55.03（P = 0.016）。对于OS，第一四分位数（25%）、中位数（50%）、第三四分位数（75%）分别如下（以月为单位）——A-wt II：21.6（中位数；P = 1）；A-mt II：60.6、85.2和109.8；OD II：86.1、96.2和106.3（P = 0.37）。
对于每种肿瘤分子亚型，都有不同的替莫唑胺治疗方案被确定为延长PFS和OS的最佳方案。此外，无论替莫唑胺治疗方案如何，A-wt II的PFS均显著短于A-mt II和OD-II。总体而言，这些数据可为患者在做出关键治疗决策时提供有用的预后信息。此外，通过梳理和评估每种替莫唑胺治疗方案的生存结果，这可能有助于未来的临床试验设计。
