Gao Sarah, Jin Lan, Moliterno Jennifer, Corbin Zachary A, Bindra Ranjit S, Contessa Joseph N, Yu James B, Park Henry S
1Department of Therapeutic Radiology, Yale School of Medicine, New Haven.
2Department of Neurosurgery, Yale School of Medicine, New Haven.
J Neurosurg. 2022 Jul 29;138(3):610-620. doi: 10.3171/2022.5.JNS212761. Print 2023 Mar 1.
Because of the aggressive nature of glioblastoma, patients with unresected disease are encouraged to begin radiotherapy within approximately 1 month after craniotomy. The aim of this study was to investigate the potential association between time interval from biopsy to radiotherapy with overall survival in patients with unresected glioblastoma.
Patients with unresected glioblastoma diagnosed between 2010 and 2014 who received adjuvant radiotherapy and concurrent chemotherapy were identified in the National Cancer Database. Demographic and clinical data were compared using chi-square and Wilcoxon rank-sum tests. Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression modeling.
Among 3456 patients with unresected glioblastoma, initiation of radiotherapy within 3 weeks of biopsy was associated with a higher hazard of death compared with later initiation of radiotherapy. After excluding patients who received radiotherapy within 3 weeks of biopsy to minimize the effects of confounders associated with short time intervals from biopsy to radiotherapy, the median interval from biopsy to radiotherapy was 32 days (IQR 27-39 days). Overall, 1782 (66.82%) patients started radiotherapy within 5 weeks of biopsy, and 885 (33.18%) patients started radiotherapy beyond 5 weeks of biopsy. On multivariable analysis, there was no significant difference in overall survival between these two groups (HR 0.96, 95% CI 0.88-1.50; p = 0.374).
In patients with unresected glioblastoma, a longer time interval from biopsy to radiotherapy does not appear to be associated with worse overall survival. However, external validation of these findings is necessary given that selection bias is a significant limitation of this study.
由于胶质母细胞瘤具有侵袭性，对于未接受手术切除的患者，建议在开颅术后约1个月内开始放疗。本研究的目的是调查未切除的胶质母细胞瘤患者从活检到放疗的时间间隔与总生存期之间的潜在关联。
在国家癌症数据库中识别出2010年至2014年间诊断为未切除的胶质母细胞瘤且接受辅助放疗和同步化疗的患者。使用卡方检验和Wilcoxon秩和检验比较人口统计学和临床数据。采用Kaplan-Meier法和Cox比例风险回归模型分析生存期。
在3456例未切除的胶质母细胞瘤患者中，与活检后较晚开始放疗相比，活检后3周内开始放疗与更高的死亡风险相关。在排除活检后3周内接受放疗的患者以尽量减少与活检到放疗时间间隔短相关的混杂因素影响后，从活检到放疗的中位间隔时间为32天（四分位间距27 - 39天）。总体而言，1782例（66.82%）患者在活检后5周内开始放疗，885例（33.18%）患者在活检后5周后开始放疗。多变量分析显示，这两组患者的总生存期无显著差异（风险比0.96，95%置信区间0.88 - 1.50；p = 0.374）。
在未切除的胶质母细胞瘤患者中，从活检到放疗的时间间隔较长似乎与较差的总生存期无关。然而，鉴于选择偏倚是本研究的一个重大局限性，这些发现需要外部验证。
