Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
Institute of Medical Informatics und Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany.
J Neurooncol. 2024 Sep;169(2):423-435. doi: 10.1007/s11060-024-04743-x. Epub 2024 Jun 23.
The introduction of molecular markers in to the diagnosis of gliomas has changed the therapeutic approach to this tumors. The aim of this study was to examine the impact of surgery on anaplastic astrocytomas (AA), which has not previously been fully elucidated.
This was a retrospective study involving a total of 143 patients who underwent surgery for primary AA in our department between 1995 and 2020.
Total tumor resection was achieved more often in patients with IDH-mutant tumors (41.09%) than in patients with IDH-wildtype tumors (30.76%). The median PFS was 1876 days for patients with IDH1 mutations and 238 days for patients with IDH-wildtype tumors. The 1-, 3-, 5- and 10-year PFS were longer in patients with total tumor resection and IDH-mutant AA (86.2%, 69%, 65.5% and 44.8%, respectively) than in patients with subtotal tumor resection and IDH-mutant AA (83.3%, 55.6%, 41.7% and 25%, respectively) and even longer compared to all IDH-wildtype tumors. The median OS was 2472 days for patients with IDH1 mutations and 434 days for patients with IDH-wildtype tumors. The 3-, 5- and 10-year OS times were longer in patients with total tumor resection and IDH-mutant AA (89.2%, 85.2% and 72.6%, respectively) than in patients with subtotal tumor resection and IDH-mutant AA (85.9%, 73.7% and 52.6%, respectively) and were even longer compared to all IDH-wildtype tumors.
Total tumor resection is more common with IDH-mutant AA than with IDH-wildtype tumors. Patients with IDH-mutant AA had significantly better PFS and OS after total tumor resection than after subtotal tumor resection and biopsy.
分子标志物在神经胶质瘤诊断中的引入改变了此类肿瘤的治疗方法。本研究旨在检查手术对间变性星形细胞瘤（AA）的影响，这一点尚未得到充分阐明。
这是一项回顾性研究，共纳入 1995 年至 2020 年期间在我科接受原发性 AA 手术的 143 名患者。
在 IDH 突变型肿瘤患者（41.09%）中，实现全肿瘤切除的比例高于 IDH 野生型肿瘤患者（30.76%）。IDH1 突变患者的中位无进展生存期（PFS）为 1876 天，IDH 野生型肿瘤患者为 238 天。全肿瘤切除且 IDH 突变 AA 患者的 1 年、3 年、5 年和 10 年 PFS 分别为 86.2%、69%、65.5%和 44.8%，均长于次全肿瘤切除且 IDH 突变 AA 患者（83.3%、55.6%、41.7%和 25%），甚至长于所有 IDH 野生型肿瘤患者。IDH1 突变患者的中位总生存期（OS）为 2472 天，IDH 野生型肿瘤患者为 434 天。全肿瘤切除且 IDH 突变 AA 患者的 3 年、5 年和 10 年 OS 分别为 89.2%、85.2%和 72.6%，均长于次全肿瘤切除且 IDH 突变 AA 患者（85.9%、73.7%和 52.6%），甚至长于所有 IDH 野生型肿瘤患者。
IDH 突变型 AA 比 IDH 野生型肿瘤更常行全肿瘤切除术。与次全肿瘤切除术和活检相比，IDH 突变 AA 患者在全肿瘤切除后具有显著更好的 PFS 和 OS。
