Woo Peter Y M, Law Tiffany H P, Lee Kelsey K Y, Chow Joyce S W, Li Lai-Fung, Lau Sarah S N, Chan Tony K T, Ho Jason M K, Lee Michael W Y, Chan Danny T M, Poon Wai-Sang
Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China.
Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China.
Br J Neurosurg. 2024 Dec;38(6):1381-1389. doi: 10.1080/02688697.2023.2167931. Epub 2023 Jan 18.
In contrast to standard-of-care treatment of newly diagnosed glioblastoma, there is limited consensus on therapy upon disease progression. The role of resection for recurrent glioblastoma remains unclear. This study aimed to identify factors for overall survival (OS) and post-progression survival (PPS) as well as to validate an existing prediction model.
This was a multi-centre retrospective study that reviewed consecutive adult patients from 2006 to 2019 that received a repeat resection for recurrent glioblastoma. The primary endpoint was PPS defined as from the date of second surgery until death.
1032 glioblastoma patients were identified and 190 (18%) underwent resection for recurrence. Patients that had second surgery were more likely to be younger (<70 years) (adjusted OR: 0.3; 95% CI: 0.1-0.6), to have non-eloquent region tumours (aOR: 1.7; 95% CI: 1.1-2.6) and received temozolomide chemoradiotherapy (aOR: 0.2; 95% CI: 0.1-0.4). Resection for recurrent tumour was an independent predictor for OS (aOR: 1.5; 95% CI: 1.3-1.7) (mOS: 16.9 months versus 9.8 months). For patients that previously received temozolomide chemoradiotherapy and subsequent repeat resection (137, 13%), the median PPS was 9.0 months (IQR: 5.0-17.5). Independent PPS predictors for this group were a recurrent tumour volume of >50cc (aOR: 0.6; 95% CI: 0.4-0.9), local recurrence (aOR: 1.7; 95% CI: 1.1-3.3) and 5-ALA fluorescence-guided resection during second surgery (aOR: 1.7; 95% CI: 1.1-2.8). A National Institutes of Health Recurrent Glioblastoma Multiforme Scale score of 0 conferred an mPPS of 10.0 months, a score of 1-2, 9.0 months and a score of 3, 4.0 months (log-rank test, -value < 0.05).
Surgery for recurrent glioblastoma can be beneficial in selected patients and carries an acceptable morbidity rate. The pattern of recurrence influenced PPS and the NIH Recurrent GBM Scale was a reliable prognostication tool.
与新诊断的胶质母细胞瘤的标准治疗方法不同，对于疾病进展后的治疗，目前尚未达成广泛共识。复发性胶质母细胞瘤切除手术的作用仍不明确。本研究旨在确定总生存期（OS）和进展后生存期（PPS）的影响因素，并验证现有的预测模型。
这是一项多中心回顾性研究，对2006年至2019年间接受复发性胶质母细胞瘤再次切除手术的成年患者进行了连续回顾。主要终点是PPS，定义为从第二次手术日期至死亡的时间。
共识别出1032例胶质母细胞瘤患者，其中190例（18%）接受了复发性肿瘤切除手术。接受第二次手术的患者更可能年龄较轻（<70岁）（调整后的OR：0.3；95%CI：0.1-0.6），肿瘤位于非功能区（aOR：1.7；95%CI：1.1-2.6），并且接受过替莫唑胺同步放化疗（aOR：0.2；95%CI：0.1-0.4）。复发性肿瘤切除是OS的独立预测因素（aOR：1.5；95%CI：1.3-1.7）（中位OS：16.9个月对9.8个月）。对于先前接受过替莫唑胺同步放化疗并随后接受再次切除手术的患者（137例，13%），中位PPS为9.0个月（IQR：5.0-17.5）。该组患者PPS的独立预测因素包括复发肿瘤体积>50cc（aOR：0.6；95%CI：0.4-0.9）、局部复发（aOR：1.7；95%CI：1.1-3.3）以及第二次手术时采用5-氨基乙酰丙酸荧光引导切除（aOR：1.7；95%CI：1.1-2.8）。美国国立卫生研究院复发性多形性胶质母细胞瘤量表评分为0时，中位PPS为10.0个月；评分为1-2时，为9.0个月；评分为3时，为4.0个月（对数秩检验，P值<0.05）。
复发性胶质母细胞瘤手术对部分患者可能有益，且发病率可接受。复发模式影响PPS，美国国立卫生研究院复发性胶质母细胞瘤量表是一种可靠的预后评估工具。
