Lamba Nayan, McAvoy Malia, Kavouridis Vasileios K, Smith Timothy R, Touat Mehdi, Reardon David A, Iorgulescu J Bryan
Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Neurooncol Pract. 2022 Jan 14;9(3):201-207. doi: 10.1093/nop/npac004. eCollection 2022 May.
The optimal chemotherapy regimen between temozolomide and procarbazine, lomustine, and vincristine (PCV) remains uncertain for WHO grade 3 oligodendroglioma (Olig3) patients. We therefore investigated this question using national data.
Patients diagnosed with radiotherapy-treated 1p/19q-codeleted Olig3 between 2010 and 2018 were identified from the National Cancer Database. The overall survival (OS) associated with first-line single-agent temozolomide vs multi-agent PCV was estimated by Kaplan-Meier techniques and evaluated by multivariable Cox regression.
One thousand five hundred ninety-six radiotherapy-treated 1p/19q-codeleted Olig3 patients were identified: 88.6% (n = 1414) treated with temozolomide and 11.4% (n = 182) with PCV (from 5.4% in 2010 to 12.0% in 2018) in the first-line setting. The median follow-up was 35.5 months (interquartile range [IQR] 20.7-60.6 months) with 63.3% of patients alive at the time of analysis. There was a significant difference in unadjusted OS between temozolomide (5-year OS 58.9%, 95%CI: 55.6-62.0) and PCV (5-year OS 65.1%, 95%CI: 54.8-73.5; = .04). However, a significant OS difference between temozolomide and PCV was not observed in the Cox regression analysis adjusted by age and extent of resection (PCV vs temozolomide HR 0.81, 95%CI: 0.59-1.11, = .18). PCV was more frequently used for younger Olig3s but otherwise was not associated with patient's insurance status or care setting.
In a national analysis of Olig3s, first-line PCV chemotherapy was associated with a slightly improved unadjusted short-term OS compared to temozolomide; but not following adjustment by patient age and extent of resection. There has been an increase in PCV utilization since 2010. These findings provide preliminary data while we await the definitive results from the CODEL trial.
对于世界卫生组织3级少突胶质细胞瘤（Olig3）患者，替莫唑胺与丙卡巴肼、洛莫司汀和长春新碱（PCV）之间的最佳化疗方案仍不确定。因此，我们使用国家数据对这个问题进行了调查。
从国家癌症数据库中识别出2010年至2018年间诊断为接受过放疗的1p/19q共缺失Olig3患者。通过Kaplan-Meier技术估计一线单药替莫唑胺与多药PCV相关的总生存期（OS），并通过多变量Cox回归进行评估。
共识别出1596例接受过放疗的1p/19q共缺失Olig3患者：一线治疗中，88.6%（n = 1414）接受替莫唑胺治疗，11.4%（n = 182）接受PCV治疗（从2010年的5.4%增至2018年的12.0%）。中位随访时间为35.5个月（四分位间距[IQR] 20.7 - 60.6个月），分析时63.3%的患者存活。替莫唑胺组（5年OS 58.9%，95%CI：55.6 - 62.0）与PCV组（5年OS 65.1%，95%CI：54.8 - 73.5；P = 0.04）的未调整OS存在显著差异。然而，在按年龄和切除范围调整的Cox回归分析中，未观察到替莫唑胺与PCV之间存在显著的OS差异（PCV与替莫唑胺相比，HR 0.81，95%CI：0.59 - 1.11，P = 0.18）。PCV更常用于较年轻的Olig3患者，但在其他方面与患者的保险状况或护理机构无关。
在一项针对Olig3的全国性分析中，与替莫唑胺相比，一线PCV化疗在未调整的短期OS方面略有改善；但在按患者年龄和切除范围调整后则不然。自2010年以来，PCV的使用有所增加。在我们等待CODEL试验的最终结果时，这些发现提供了初步数据。
