IEEE Trans Biomed Eng. 2022 Jun;69(6):1889-1900. doi: 10.1109/TBME.2021.3130195. Epub 2022 May 19.
This translational study aims to investigate the clinical benefits of indocyanine green (ICG) based near-infrared window II (NIR-II) fluorescence image-guided surgery (FGS) on high-grade glioma (HGG) patients.
Patients were randomly assigned to receive FGS or traditional white light image-guided surgery (WLS). The detection rate of NIR-II fluorescence was observed. Complete resection rate, progression-free survival (PFS), overall survival (OS), and neurological status were compared. Tissue samples were obtained from the FGS group, with the diagnosis based on the surgeons and the fluorescence recorded for comparison of diagnostic capability. Patients with WHO grade III gliomas or glioblastomas (GBM) were analyzed separately.
15 GBM and 4 WHO grade III glioma patients in the FGS group and 18 GBM and 4 WHO grade III glioma patients in the WLS group were enrolled. The detection rate of NIR-II fluorescence was 100% for GBM. The complete resection rate was significantly increased by the FGS for GBM (FGS, 100% [95% CI 73.41-100] vs. WLS, 50% [95% CI 29.03-70.97], P = 0.0036). The PFS and OS of the FGS group were also significantly prolonged (Median PFS: FGS, 9.0 months vs. WLS, 7.0 months, P < 0.0001; Median OS: FGS, 19.0 months vs. WLS, 15.5 months, P = 0.0002). No recurrence was observed in WHO grade III glioma patients.
NIR-II FGS achieves a much better complete resection rate of GBM than conventional WLS, leading to greatly improved survival of GBM patients.
NIR-II FGS is a highly promising technique worthy of exploring more clinical applications.
本研究旨在探讨吲哚菁绿（ICG）基近红外二区（NIR-II）荧光影像引导手术（FGS）对高级别胶质瘤（HGG）患者的临床获益。
患者被随机分配接受 FGS 或传统白光影像引导手术（WLS）。观察 NIR-II 荧光的检测率。比较完全切除率、无进展生存期（PFS）、总生存期（OS）和神经状态。从 FGS 组获取组织样本，根据外科医生的诊断和记录的荧光进行比较，以评估诊断能力。对 WHO 分级 III 级胶质瘤或胶质母细胞瘤（GBM）患者分别进行分析。
FGS 组纳入 15 例 GBM 和 4 例 WHO 分级 III 级胶质瘤患者，WLS 组纳入 18 例 GBM 和 4 例 WHO 分级 III 级胶质瘤患者。GBM 的 NIR-II 荧光检测率为 100%。FGS 可显著提高 GBM 的完全切除率（FGS，100%[95%CI73.41-100] vs. WLS，50%[95%CI29.03-70.97]，P=0.0036）。FGS 组的 PFS 和 OS 也显著延长（中位 PFS：FGS，9.0 个月 vs. WLS，7.0 个月，P<0.0001；中位 OS：FGS，19.0 个月 vs. WLS，15.5 个月，P=0.0002）。WHO 分级 III 级胶质瘤患者无复发。
NIR-II FGS 可实现比传统 WLS 更好的 GBM 完全切除率，从而显著提高 GBM 患者的生存率。
NIR-II FGS 是一种很有前途的技术，值得进一步探索其临床应用。
