Bonomo Giulio, Certo Francesco, Grasso Erica, Fiumanò Giuseppa, Barbagallo Davide, Caltabiano Rosario, Broggi Giuseppe, Magro Gaetano, Maugeri Andrea, Agodi Antonella, Latteri Fiorenza, Sotoparra Hector, Buscema Giovanni, Spatola Corrado, Pluchino Alessandro, Barbagallo Giuseppe M V
Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, 95121 Catania, Italy.
Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123 Catania, Italy.
Brain Sci. 2025 Apr 23;15(5):428. doi: 10.3390/brainsci15050428.
Although several studies investigated the efficacy of long-term adjuvant temozolomide (TMZ) therapy in glioblastomas (GBs), no univocal data are currently available, and this topic remains controversial. The present study on our ongoing experience aims to assess whether the extended STUPP protocol confers prognostic benefits with acceptable safety. From 2004 to 2018, 81 patients with a new diagnosis of GB according to the World Health Organization (WHO) 2021 classification, treated with gross total resection (GTR) or subtotal resection (STR), were enrolled. Patients were divided into Group A (long-term TMZ; N = 40) and Group B (standard STUPP protocol; N = 41). In the extended STUPP group, compared with the standard STUPP group, progression-free survival (PFS) and overall survival (OS) were significantly improved (PFS: 27.8 vs. 7.5 months, = 0.00001; OS: 35.9 vs. 11.3 months, = 0.0001). To mitigate a potential survival bias, we focused on those in Group B who completed the recommended six cycles. Patients in Group A demonstrated a prolonged OS compared to Group B (27 vs. 10 months, < 0.001). Similar findings were observed in a focused analysis of patients who had achieved a minimum survival of 12 months (27 vs. 15 months, < 0.001) or 18 months (34 vs. 24 months, = 0.044). Our analysis demonstrates a PFS and OS advantage with extended STUPP and suggests that young patients without corpus callosum invasion, with methylguanine-DNA methyltransferase (MGMT) promoter methylation, and treated with GTR are the best candidates. No significant safety difference emerged between extended and standard TMZ treatment.
尽管多项研究探讨了长期辅助替莫唑胺（TMZ）治疗胶质母细胞瘤（GB）的疗效，但目前尚无统一的数据，且该话题仍存在争议。本研究基于我们目前的经验，旨在评估扩展的STUPP方案在可接受的安全性下是否能带来预后益处。2004年至2018年，纳入了81例根据世界卫生组织（WHO）2021年分类新诊断为GB的患者，这些患者接受了全切除（GTR）或次全切除（STR）治疗。患者分为A组（长期TMZ；n = 40）和B组（标准STUPP方案；n = 41）。在扩展的STUPP组中，与标准STUPP组相比，无进展生存期（PFS）和总生存期（OS）显著改善（PFS：27.8个月对7.5个月，= 0.00001；OS：35.9个月对11.3个月，= 0.0001）。为减轻潜在的生存偏倚，我们关注B组中完成推荐的六个周期的患者。A组患者的OS比B组延长（27个月对10个月，< 0.001）。在对生存至少12个月（27个月对15个月，< 0.001）或18个月（34个月对24个月，= 0.044）的患者进行的重点分析中也观察到了类似的结果。我们的分析表明，扩展的STUPP方案具有PFS和OS优势，并表明没有胼胝体侵犯、甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子甲基化且接受GTR治疗的年轻患者是最佳候选者。扩展和标准TMZ治疗之间未出现显著的安全性差异。
