Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Neurology, National Neuroscience Institute, Singapore, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore.
J Clin Neurosci. 2023 Sep;115:60-65. doi: 10.1016/j.jocn.2023.07.016. Epub 2023 Jul 22.
Overall survival (OS)for glioblastoma multiforme (GBM) has a known association with the extent of tumor resection with gross total resection (GTR) typically considered as the upper limit. In certain regions such as the anterior temporal lobe, more extensive resection by means of a lobectomy may be feasible. In our systematic review and meta-analysis, we aimed to compare the outcomes of lobectomy and GTR for GBM. PubMed and Embase were queriedfor studies that compared the outcomes after lobectomy or GTR for GBM. The primary outcomes were OS, progression-free survival (PFS), and Karnofksy Performance Status (KPS) score at the latest follow-up. The secondary outcomes were seizure control at the latest follow-up and complication rates. Meta-analysis for OS and PFS was performed using individual-participant data reconstructed from published Kaplan-Meier curves. Random-effect meta-analysis was performed for KPS. The secondary outcomes were pooled using descriptive statistics. Of the 795 records screened, 6 were included in our study. Meta-analysis revealed that anterior temporal, frontal, or occipital lobectomy was associated with significantly better OS (p < 0.001) and PFS (p < 0.001) than GTR, but not KPS (MD = 6.37; 95% CI=(-13.80, 26.54); p = 0.536). Anterior temporal lobectomy was associated with significantly better seizure control rates than GTR for temporal GBM (OR = 27; 95% CI=(1.4, 515.9); p = 0.002). There was no statistically significant difference in complication rates between anterior temporal, frontal, or occipital lobectomy and GTR. In conclusion, lobectomy was associated with significantly better OS, PFS, and seizure control than GTR for GBM.
总体生存（OS）对于多形性胶质母细胞瘤（GBM）与肿瘤切除程度有关，大体全切除（GTR）通常被认为是上限。在某些区域，如前颞叶，可以通过叶切除术进行更广泛的切除。在我们的系统评价和荟萃分析中，我们旨在比较 GBM 患者行叶切除术与 GTR 的结果。我们在 PubMed 和 Embase 上检索了比较 GBM 患者行叶切除术或 GTR 后结果的研究。主要结局是 OS、无进展生存（PFS）和最新随访时的 Karnofksy 表现状态（KPS）评分。次要结局是最新随访时的癫痫发作控制率和并发症发生率。使用从已发表的 Kaplan-Meier 曲线重建的个体参与者数据对 OS 和 PFS 进行了荟萃分析。使用随机效应荟萃分析对 KPS 进行了分析。使用描述性统计对次要结局进行了汇总。在筛选出的 795 条记录中，有 6 条被纳入我们的研究。荟萃分析显示，前颞叶、额叶或枕叶切除术与 GTR 相比，OS（p<0.001）和 PFS（p<0.001）显著改善，但 KPS 无差异（MD=6.37；95%CI=（-13.80，26.54）；p=0.536）。与 GTR 相比，前颞叶切除术与颞叶 GBM 的癫痫发作控制率显著提高（OR=27；95%CI=（1.4，515.9）；p=0.002）。前颞叶、额叶或枕叶切除术与 GTR 之间的并发症发生率无统计学差异。结论：与 GTR 相比，叶切除术与 GBM 的 OS、PFS 和癫痫发作控制率显著提高。
