Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
Department of Neurosurgery, King's College Hospital, King's College Hospital NHS Foundation Trust, London, UK.
J Neurooncol. 2022 Dec;160(3):717-724. doi: 10.1007/s11060-022-04192-4. Epub 2022 Nov 21.
Surgical resection offers survival benefits in patients with diffuse low-grade glioma (DLGG) but its association with functional outcomes is uncertain. This systematic review assessed functional outcomes associated with extent of resection (EoR) in adults with DLGG.
We searched Medline, Embase and CENTRAL on the 19th of February 2021 for observational studies reporting functional outcomes after surgical resection for patients aged ≥ 18 years with a new diagnosis of supratentorial DLGG according to any World Health Organization classification of primary brain tumors. The Newcastle-Ottawa Scale (NOS) informed our risk of bias assessments. The proportion of patients returning to work within 12 months entered a random-effects meta-analysis. PROSPERO registration number CRD42021238387.
There were seven eligible moderate to high-quality (NOS > 6) observational studies identified from 1,183 records involving 234 patients with DLGG. Functional outcomes reported included neurocognition (n = 2 studies), performance status (n = 3), quality of life (QoL) (n = 1) and return to work (n = 6). The proportion of patients who returned to work within 12 months of surgery was 84% (95% confidence interval [CI] 50-96%, I-squared = 38%, 5 studies) for gross total resection, 66% (95% CI 14-96%, I = 57%, 5 studies) for subtotal resection, and 31% (95% CI 4-82%, I = 0%, 4 studies) for partial resection. There was insufficient data on other functional outcomes for quantitative synthesis.
A higher proportion of DLGG patients returned to work following gross total resection compared with those who had a subtotal or partial resection. Further studies with standardized assessments can clarify the association between EoR and different functional outcomes.
手术切除可为弥漫性低级别胶质瘤（DLGG）患者带来生存获益，但手术切除与功能结局的关联尚不确定。本系统评价评估了在根据任何世界卫生组织原发性脑肿瘤分类新诊断为幕上 DLGG 的成年患者中，手术切除程度（EoR）与功能结局的关联。
我们于 2021 年 2 月 19 日检索了 Medline、Embase 和 CENTRAL，以纳入报告了根据任何世界卫生组织原发性脑肿瘤分类新诊断为幕上 DLGG 的成年患者手术切除后功能结局的观察性研究。我们使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。将 12 个月内恢复工作的患者比例纳入随机效应荟萃分析。PROSPERO 注册号为 CRD42021238387。
从 1183 份记录中确定了 7 项符合条件的中高质量（NOS＞6）观察性研究，共纳入 234 例 DLGG 患者。报告的功能结局包括神经认知（n=2 项研究）、功能状态（n=3 项研究）、生活质量（QoL）（n=1 项研究）和恢复工作（n=6 项研究）。全切除术后 12 个月内恢复工作的患者比例为 84%（95%置信区间 [CI] 50-96%，I2=38%，5 项研究），次全切除术后为 66%（95% CI 14-96%，I=57%，5 项研究），部分切除术后为 31%（95% CI 4-82%，I=0%，4 项研究）。由于数据不足，无法进行定量综合分析其他功能结局。
与次全切除或部分切除相比，DLGG 患者全切除后更有可能恢复工作。进一步的研究采用标准化评估方法可以阐明 EoR 与不同功能结局的关系。
