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胶质母细胞瘤患者的非计划30天再入院:对切除范围和辅助治疗的影响

Unplanned 30-Day Readmission in Glioblastoma Patients: Implications for the Extent of Resection and Adjuvant Therapy.

作者信息

Kasper Johannes, Wach Johannes, Vychopen Martin, Arlt Felix, Güresir Erdem, Wende Tim, Wilhelmy Florian

机构信息

Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany.

出版信息

Cancers (Basel). 2023 Aug 1;15(15):3907. doi: 10.3390/cancers15153907.

Abstract

BACKGROUND

Unplanned early readmission (UER) within 30 days after hospital release is a negative prognostic marker for patients diagnosed with glioblastoma (GBM). This work analyzes the impact of UER on the effects of standard therapy modalities for GBM patients, including the extent of resection (EOR) and adjuvant therapy regimen.

METHODS

Records were searched for patients with newly diagnosed GBM between 2014 and 2020 who were treated at our facility. Exclusion criteria were being aged below 18 years or missing data. An overall survival (OS) analysis (Kaplan-Meier estimate; Cox regression) was performed on various GBM patient sub-cohorts.

RESULTS

A total of 276 patients were included in the study. UER occurred in 13.4% ( = 37) of all cases, significantly reduced median OS (5.7 vs. 14.5 months, < 0.001 by logrank), and was associated with an increased hazard of mortality (hazard ratio 3.875, < 0.001) in multivariate Cox regression when other clinical parameters were applied as confounders. The Kaplan-Meier analysis also showed that patients experiencing UER still benefitted from adjuvant radio-chemotherapy when compared to radiotherapy or no adjuvant therapy ( < 0.001 by logrank). A higher EOR did not improve OS in GBM patients with UER ( = 0.659).

CONCLUSION

UER is negatively associated with survival in GBM patients. In contrast to EOR, adjuvant radio-chemotherapy was beneficial, even after UER.

摘要

背景

胶质母细胞瘤(GBM)患者出院后30天内的非计划早期再入院(UER)是一个不良预后指标。本研究分析了UER对GBM患者标准治疗方式效果的影响,包括手术切除范围(EOR)和辅助治疗方案。

方法

检索2014年至2020年间在我院接受治疗的新诊断GBM患者的记录。排除标准为年龄低于18岁或数据缺失。对不同GBM患者亚组进行总生存(OS)分析(Kaplan-Meier估计;Cox回归)。

结果

本研究共纳入276例患者。UER发生在所有病例的13.4%(n = 37)中,显著缩短了中位OS(5.7个月对14.5个月,logrank检验P < 0.001),并且在多因素Cox回归中,当将其他临床参数作为混杂因素时,UER与死亡风险增加相关(风险比3.875,P < 0.001)。Kaplan-Meier分析还显示,与单纯放疗或无辅助治疗相比,发生UER的患者仍能从辅助放化疗中获益(logrank检验P < 0.001)。较高的EOR并未改善发生UER的GBM患者的OS(P = 0.659)。

结论

UER与GBM患者的生存呈负相关。与EOR不同,辅助放化疗是有益的,即使在发生UER后也是如此。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bd67/10417525/2aab473cfe32/cancers-15-03907-g001.jpg

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