Department of Neurosurgery,American Hospital, Istanbul, Turkey.
Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey.
Cancer Control. 2024 Jan-Dec;31:10732748241288121. doi: 10.1177/10732748241288121.
This study aimed to assess if extensive surgical resection enhances outcomes in wild-type Isocitrate Dehydrogenase (IDH) butterfly glioblastoma (B-GBM) patients, despite the presence of Telomerase Reverse Transcriptase (TERT) mutation and Epidermal Growth Factor Receptor (EGFR) amplification.
The study, retrospectively conducted from 2014 to 2022, involved 723 GBM patients, 41 of whom met the criteria for IDH wild-type B-GBM. Exclusion criteria comprised prior diagnoses or treatments for low-grade glial tumors. Surgeons, employing two approaches-partial and extensive surgery-categorized patients based on age, sex, tumor location, corpus callosum involvement, and genetic characteristics. The interval between initial surgery and tumor recurrence/tumor-free period (TR/TFP) and overall survival (OS) were recorded and compared between the partial and extensive resection groups, analyzing the impact of resection width on TR/TFP and OS. Preoperative assessments utilized thin-section cranial computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI). Intraoperatively, tumor excision was guided by sodium fluorescein, and margins were delineated via neuronavigation. Genetic alterations (TERT mutations and EGFR amplifications) were correlated with surgical type, TR/TFP, and OS. Karnofsky Performance Scale (KPS) evaluations were performed pre- and post-operatively and at key intervals, comparing outcomes between surgical groups. Standard radiotherapy and chemotherapy regimens were administered to all patients.
Extensive resection yielded significantly longer TR/TFP compared to partial resection, despite TERT gene mutation and EGFR amplification being linked to shorter TR/TFP and OS. Its impact on OS, however, was not significant. KPS scores indicated a superior quality of life after extensive resection, with sustained improvement upon recurrence.
Extensive resection of B-GBM, even in the presence of adverse genetic alterations, may prolong TR/TFP, offering patients a period of improved comfort with minimal distress.
本研究旨在评估广泛手术切除是否能改善野生型异柠檬酸脱氢酶（IDH）蝶形胶质母细胞瘤（B-GBM）患者的预后，尽管存在端粒酶逆转录酶（TERT）突变和表皮生长因子受体（EGFR）扩增。
本研究回顾性地从 2014 年至 2022 年进行，涉及 723 名 GBM 患者，其中 41 名符合 IDH 野生型 B-GBM 的标准。排除标准包括既往诊断或治疗低度神经胶质瘤。外科医生根据年龄、性别、肿瘤位置、胼胝体受累情况和遗传特征，采用部分和广泛手术两种方法对患者进行分类。记录并比较了初始手术与肿瘤复发/无肿瘤期（TR/TFP）和总生存期（OS）之间的间隔，分析了切除宽度对 TR/TFP 和 OS 的影响。术前评估采用薄层头颅 CT 和增强磁共振成像（MRI）。术中，肿瘤切除由荧光素钠引导，并用神经导航勾勒出边缘。肿瘤切除由荧光素钠引导，并用神经导航勾勒出边缘。基因改变（TERT 突变和 EGFR 扩增）与手术类型、TR/TFP 和 OS 相关。术前和术后及关键时间点进行卡氏功能状态量表（KPS）评估，比较手术组的结果。所有患者均接受标准放疗和化疗方案。
尽管 TERT 基因突变和 EGFR 扩增与较短的 TR/TFP 和 OS 相关，但广泛切除与部分切除相比，TR/TFP 显著延长。然而，它对 OS 的影响并不显著。KPS 评分表明广泛切除后生活质量更高，复发后持续改善。
即使存在不利的遗传改变，广泛切除 B-GBM 也可能延长 TR/TFP，为患者提供一段改善舒适度且痛苦最小的时期。
