Champeaux-Depond Charles, Jecko Vincent, Weller Joconde, Constantinou Panayotis, Tuppin Philippe, Metellus Philippe
Department of Neurosurgery, Hôpital privé Clairval - Ramsay Santé, Marseille, France.
Department of Neurosurgery, Pellegrin Hospital, Bordeaux, France.
World Neurosurg. 2023 May;173:e778-e786. doi: 10.1016/j.wneu.2023.03.015. Epub 2023 Mar 10.
Widespread use of carmustine wafers (CWs) to treat high-grade gliomas (HGG) has been limited by uncertainties about their efficacy. We sought to assess the outcome of patients after newly diagnosed HGG surgery with CW implantation and search for associated factors.
We processed the French medico-administrative national database between 2008 and 2019 to retrieve ad hoc cases. Survival methods were implemented.
In total, 1608 patients who had CW implantation after HGG resection at 42 different institutions between 2008 and 2019 were identified; 36.7% were female and, median age at HGG resection with CW implantation was 61.5 years, interquartile range (IQR) [52.9-69.1]. A total of 1460 patients (90.8%) had died at data collection at a median age at death of 63.5 years, IQR [55.3-71.2]. Median overall survival (OS) was 1.42 years, 95% confidence interval [CI] 1.35-1.49, i.e., 16.8 months. Median age at death was 63.5 years, IQR [55.3-71.2]. OS at 1, 2, and, 5 years was 67.4%, 95% CI 65.1-69.7; 33.1%, 95% CI 30.9-35.5; and 10.7%, 95% CI 9.2-12.4, respectively. In the adjusted regression, sex (hazard ratio [HR] 0.82, 95% CI 0.74-0.92, P < 0.001), age at HGG surgery with CW implantation (HR 1.02, 95% CI 1.02-1.03, P < 0.001), adjuvant radiotherapy (HR 0.78, 95% CI 0.7-0.86, P < 0.001), chemotherapy by temozolomide (HR 0.7, 95% CI 0.63-0.79, P < 0.001), and redo surgery for HGG recurrence (HR 0.81, 95% CI 0.69-0.94, P = 0.005) remained significantly associated with the outcome.
OS of patients with newly diagnosed HGG who underwent surgery with CW implantation is better in young patients, those of the female sex, and for those who complete concomitant chemoradiotherapy. Redo surgery for HGG recurrence also was associated with prolonged survival.
卡莫司汀晶片（CWs）在治疗高级别胶质瘤（HGG）方面的广泛应用受到其疗效不确定性的限制。我们试图评估新诊断的HGG手术后植入CWs的患者的预后，并寻找相关因素。
我们处理了2008年至2019年期间法国的医疗行政国家数据库，以检索特定病例。采用了生存分析方法。
总共确定了2008年至2019年期间在42个不同机构接受HGG切除术后植入CWs的1608例患者；36.7%为女性，植入CWs的HGG切除时的中位年龄为61.5岁，四分位间距（IQR）为[52.9 - 69.1]。在数据收集时，共有1460例患者（90.8%）死亡，死亡时的中位年龄为63.5岁，IQR为[55.3 - 71.2]。中位总生存期（OS）为1.42年，95%置信区间（CI）为1.35 - 1.49，即16.8个月。死亡时的中位年龄为63.5岁，IQR为[55.3 - 71.2]。1年、2年和5年的OS分别为67.4%，95% CI为65.1 - 69.7；33.1%，95% CI为30.9 - 35.5；以及10.7%，95% CI为9.2 - 12.4。在调整后的回归分析中，性别（风险比[HR]为0.82，95% CI为0.74 - 0.92，P < 0.001）、植入CWs的HGG手术时的年龄（HR为1.02，95% CI为1.02 - 1.03，P < 0.001）、辅助放疗（HR为0.78，95% CI为0.7 - 0.86，P < 0.001）、替莫唑胺化疗（HR为来0.7，95% CI为0.63 - 0.79，P < 0.001）以及因HGG复发进行的再次手术（HR为0.81，95% CI为0.69 - 0.94，P = 0.005）仍然与预后显著相关。
新诊断的HGG患者接受植入CWs手术的OS在年轻患者、女性以及完成同步放化疗的患者中更好。因HGG复发进行的再次手术也与生存期延长相关。
