Champeaux-Depond Charles, Jecko Vincent, Weller Joconde, Constantinou Panayotis, Tuppin Philippe, Metellus Philippe
Department of Neurosurgery, Hôpital Privé Clairval - Ramsay Santé, 317 Bd du Redon, 13009, Marseille, France.
Department of Neurosurgery, Pellegrin Hospital, 33000, Bordeaux, France.
J Neurooncol. 2023 Apr;162(2):343-352. doi: 10.1007/s11060-023-04295-6. Epub 2023 Mar 29.
Widespread use of carmustine wafers (CW) to treat high-grade gliomas (HGG) has been limited by uncertainties about its efficacy. To assess the outcome of patients after recurrent 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.
559 patients who had CW implantation after recurrent HGG resection at 41 different institutions between 2008 and 2019 were identified. 35.6% were female and, median age at HGG resection with CW implantation was 58.1 years, IQR [50-65.4]. 520 patients (93%) had died at data collection with a median age at death of 59.7 years, IQR [51.6-67.1]. Median overall survival (OS) was 1.1 years, CI[0.97-1.2], id est 13.2 months. Median age at death was 59.7 years, IQR [51.6-67.1]. OS at 1, 2 and 5 years was 52.1%, CI[48.1-56.4], 24.6%, CI[21.3-28.5] & 8%, CI[5.9-10.7] respectively. In the adjusted regression, bevacizumab given before CW implantation, (HR = 1.98, CI[1.49-2.63], p < 0.001), a longer delay between the first and the second HGG surgery (HR = 1, CI[1-1], p < 0.001), RT given before and after CW implantation (HR = 0.59, CI[0.39-0.87], p = 0.009) and TMZ given before and after CW implantation (HR = 0.81, CI[0.66-0.98], p = 0.034) remained significantly associated with a longer survival.
OS of patients with recurrent HGG that underwent surgery with CW implantation is better in case of prolonged delay between the two resections and, for the patients who had RT and TMZ before and after CW implantation.
卡莫司汀晶片（CW）在治疗高级别胶质瘤（HGG）中的广泛应用受到其疗效不确定性的限制。评估复发性HGG手术后植入CW患者的预后，并寻找相关因素。
我们处理了2008年至2019年期间法国国家医疗行政数据库以检索特定病例。采用了生存分析方法。
确定了2008年至2019年期间在41个不同机构接受复发性HGG切除术后植入CW的559例患者。35.6%为女性，植入CW时HGG切除的中位年龄为58.1岁，四分位间距[50 - 65.4]。在数据收集时，520例患者（93%）已死亡，死亡中位年龄为59.7岁，四分位间距[51.6 - 67.1]。中位总生存期（OS）为1.1年，置信区间[0.97 - 1.2]，即13.2个月。死亡中位年龄为59.7岁，四分位间距[51.6 - 67.1]。1年、2年和5年的OS分别为52.1%，置信区间[48.1 - 56.4]、24.6%，置信区间[21.3 - 28.5]和8%，置信区间[5.9 - 10.7]。在调整后的回归分析中，CW植入前给予贝伐单抗（HR = 1.98，置信区间[1.49 - 2.63]，p < 0.001）、首次和第二次HGG手术之间间隔时间更长（HR = 1，置信区间[1 - 1]，p < 0.001）、CW植入前后给予放疗（HR = 0.59，置信区间[0.39 - 0.87]，p = 0.009）以及CW植入前后给予替莫唑胺（HR = 0.81，置信区间[0.66 - 0.98]，p = 0.034）仍与更长生存期显著相关。
复发性HGG患者接受手术并植入CW后，两次切除之间间隔时间延长以及在CW植入前后接受放疗和替莫唑胺治疗的患者总生存期更好。
