Hou Ziming, Hu Jie, Liu Xing, Yan Zeya, Zhang Kenan, Fang Shengyu, Jiang Tao, Wang Yinyan
Department of Neurosurgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Area A, Nansihuanxi Road, Fengtai District, Beijing, 100070, China.
J Neurooncol. 2023 Sep;164(2):461-471. doi: 10.1007/s11060-023-04420-5. Epub 2023 Sep 5.
Extensive surgical resection has been found to be associated with longer survival in patients with gliomas, but the interactive prognostic value of molecular pathology of the surgical resection is unclear. This study evaluated the impact of molecular pathology and clinical characteristics on the surgical benefit in WHO grade 3 IDH-mutant gliomas.
Clinical and pathological information of 246 patients with WHO grade 3 IDH-mutant gliomas were collected from the Chinese Glioma Genome Atlas database (2006-2020). The role of the extent of resection on overall survival, stratified by molecular pathology and clinical characteristics, was investigated. We then assessed prognostic factors using a univariate log-rank test and multivariate Cox proportional hazards model in the subgroups.
The extent of resection was an independent prognostic factor in the entire cohort, even when adjusted for molecular pathology. Gross total resection was found to be associated with longer survival in all patients and in the astrocytoma group but not in the oligodendroglioma group. Compared with subtotal resections, gross total resections resulted in a longer survival time for astrocytoma patients aged ≤ 45 years. However, there was no survival benefit from total resection in patients with astrocytoma aged > 45 years.
Extensive resection benefits only a proportion of patients with WHO grade 3 IDH-mutant gliomas. Younger patients with astrocytomas had survival benefits from extensive resection. In addition to clinical characteristics (especially age), molecular pathology impacted prognosis in patients with gliomas. Our findings provide guiding information to neurosurgeons while planning surgeries.
广泛手术切除已被发现与胶质瘤患者更长的生存期相关，但手术切除的分子病理学的交互预后价值尚不清楚。本研究评估了分子病理学和临床特征对世界卫生组织（WHO）3级异柠檬酸脱氢酶（IDH）突变型胶质瘤手术获益的影响。
从中国胶质瘤基因组图谱数据库（2006 - 2020年）收集了246例WHO 3级IDH突变型胶质瘤患者的临床和病理信息。研究了切除范围在分子病理学和临床特征分层下对总生存期的作用。然后我们在亚组中使用单因素对数秩检验和多因素Cox比例风险模型评估预后因素。
即使在调整分子病理学因素后，切除范围仍是整个队列中的独立预后因素。在所有患者以及星形细胞瘤组中，肉眼全切与更长的生存期相关，但在少突胶质细胞瘤组中并非如此。与次全切除相比，对于年龄≤45岁的星形细胞瘤患者，肉眼全切导致更长的生存时间。然而，年龄>45岁的星形细胞瘤患者进行全切并没有生存获益。
广泛切除仅使一部分WHO 3级IDH突变型胶质瘤患者获益。年龄较轻的星形细胞瘤患者从广泛切除中获得生存益处。除了临床特征（尤其是年龄）外，分子病理学也影响胶质瘤患者的预后。我们的研究结果为神经外科医生在规划手术时提供了指导信息。
