Di Cristofori Andrea, Rui Chiara Benedetta, Graziano Francesca, Ferlito Davide, Rebora Paola, Trezza Andrea, Chiarello Gaia, Stefanoni Giovanni, Da Re Fulvio, Julita Chiara, Basso Gianpaolo, Palumbo Giovanni, Valsecchi Maria Grazia, Carrabba Giorgio, Giussani Carlo
Department of Medicine and Surgery, University of Milano-Bicocca, Ospedale San Gerardo, Milan, Italy.
Neurosurgery, Fondazione IRCCS San Gerardo Dei Tintori, Via G.B. Pergolesi 33, 20900, Monza, (MB), Italy.
Brain Spine. 2025 May 15;5:104276. doi: 10.1016/j.bas.2025.104276. eCollection 2025.
INTRODUCTION: Maximal resection has a pivotal role in the treatment of glioblastoma (GB), prolonging both progression free survival (PFS) and overall survival (OS). Only few studies analyze the delicate equilibrium between maximal resection, clinical outcome and prognosis. RESEARCH QUESTION: the aim of this work is to determine the impact of neurological impairment on PFS, OS and access to adjuvant therapies on patients with GB operated with perilesional resection technique.Material and Methods: this retrospective study encompassed patients operated for GB at Fondazione IRCCS San Gerardo dei Tintori Monza (IT), from 2015 to 2023. Histological diagnosis was performed according to the WHO 2021 classification. Patients were more than 18 years old, with pre- and postoperative MRI, who underwent surgery and adjuvant treatments at our Institution. RESULTS: A total of 209 patients fulfilled the criteria. Patients with improvement or complete regression of preoperative deficit had a higher rate of access to adjuvant therapies (p = 0.015). Patients with hemiparesis at discharge had the worst PFS (median 4.60 months) followed by patients with aphasia (6.60 months), and patients with normal neurological examination (9.67 months; p < 0.0001). The median OS was 17.93 months for patients with hemianopia 6.40 for patients with hemiparesis and 15.7 months for those with aphasia (p < 0.0001). DISCUSSION AND CONCLUSION: Hemianopia has no impact on the patient's prognosis, while hemiparesis and aphasia at discharge worsen both PFS and OS prolonging time-to-treatment. When resecting GB, it is mandatory to avoid major neurological deficits that concur which reduce OS and PFS.
引言：最大限度切除在胶质母细胞瘤（GB）的治疗中起着关键作用，可延长无进展生存期（PFS）和总生存期（OS）。仅有少数研究分析了最大限度切除、临床结果和预后之间的微妙平衡。 研究问题：本研究的目的是确定神经功能障碍对采用病变周围切除技术手术的GB患者的PFS、OS以及辅助治疗可及性的影响。材料与方法：这项回顾性研究纳入了2015年至2023年在意大利蒙扎圣杰拉尔多·德伊·廷托里基金会IRCCS接受GB手术的患者。组织学诊断依据世界卫生组织2021年分类标准进行。患者年龄超过18岁，术前行MRI检查，术后行MRI检查，在我们机构接受了手术及辅助治疗。 结果：共有209例患者符合标准。术前缺损改善或完全消退的患者接受辅助治疗的比例更高（p = 0.015）。出院时偏瘫患者的PFS最差（中位时间4.60个月），其次是失语患者（6.60个月），神经检查正常的患者PFS为9.67个月（p < 0.0001）。偏盲患者的中位OS为17.93个月，偏瘫患者为6.40个月，失语患者为15.7个月（p < 0.0001）。 讨论与结论：偏盲对患者预后无影响，而出院时的偏瘫和失语会使PFS和OS恶化，延长治疗时间。在切除GB时，必须避免出现会降低OS和PFS的严重神经功能缺损。
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