Arvaniti Christina K, Karagianni Maria D, Papageorgakopoulou Manthia A, Brotis Alexandros G, Tasiou Anastasia, Fountas Kostas N
Department of Neurosurgery, University Hospital of Larissa, Larissa, 41110, Greece.
School of Medicine, General University Hospital of Patras, Patras, 26504, Greece.
Brain Spine. 2024 Apr 23;4:102823. doi: 10.1016/j.bas.2024.102823. eCollection 2024.
Lobectomy has recently been employed in the management of glioblastoma (GB). Compared to subtotal, gross total and supramarginal resection, lobectomy provides maximum cytoreduction and improves overall survival (OS).
The primary aim of this study is to compare lobectomy to other techniques for managing GB in terms of OS and progression-free survival (PFS). This study evaluated the association of the available surgical techniques for GB management with the reported relevant seizure outcome, operation time, length of stay, complication incidence, and Karnofsky performance status.
A PRISMA-compliant systematic review and meta-analysis was performed. We searched PubMed, Scopus, and Web of Science from January 2013 until April 2023. Random-effects models were employed. The Newcastle-Ottawa scale (NOS) and the GRADE approach were used for estimating risk of bias and quality of evidence.
We included six studies. Lobectomy demonstrated a mean OS of 25 months, compared to 13.72 months for gross total resection (GTR), and a PFS of 16.13 months, compared to 8.77 months for GTR. Comparing lobectomy to GTR, no statistically significant differences were observed regarding seizure management, length of stay, operation time, complications, and KPS due to limited amount of data.
Our analysis demonstrated that lobectomy compared to GTR has a tremendous impact on the OS and the PFS, which seems to be improved almost by a year. Lobectomy, while demanding from a technical standpoint, constitutes a safe surgical procedure but further studies should assess its exact role in the management of GB patients.
肺叶切除术最近已被应用于胶质母细胞瘤（GB）的治疗。与次全切除、全切除和超边缘切除相比，肺叶切除术能实现最大程度的肿瘤细胞减灭并改善总生存期（OS）。
本研究的主要目的是比较肺叶切除术与其他治疗GB的技术在总生存期（OS）和无进展生存期（PFS）方面的差异。本研究评估了GB治疗中可用的手术技术与报告的相关癫痫发作结果、手术时间、住院时间、并发症发生率和卡诺夫斯基性能状态之间的关联。
进行了一项符合PRISMA标准的系统评价和荟萃分析。我们检索了2013年1月至2023年4月期间的PubMed、Scopus和Web of Science数据库。采用随机效应模型。使用纽卡斯尔-渥太华量表（NOS）和GRADE方法评估偏倚风险和证据质量。
我们纳入了六项研究。肺叶切除术的平均总生存期为25个月，而全切除（GTR）为13.72个月；肺叶切除术的无进展生存期为16.13个月，而全切除为8.77个月。由于数据量有限，在癫痫管理、住院时间、手术时间、并发症和卡诺夫斯基性能状态方面，肺叶切除术与全切除相比未观察到统计学上的显著差异。
我们的分析表明，与全切除相比，肺叶切除术对总生存期和无进展生存期有巨大影响，似乎能将生存期延长近一年。肺叶切除术虽然在技术上要求较高，但却是一种安全的手术方法，但进一步的研究应评估其在GB患者治疗中的确切作用。
