Ryskeldiyev Nurzhan, Moldabekov Aidos, Berdibayeva Dinara, Maidan Aiman, Tursynbekov Torebek, Davletov Dimash, Tleubergenov Muratbek, Kabykenova Assel, Kerimbayeva Diana, Doskaliyev Aidos, Akshulakov Serik
National Centre for Neurosurgery, Astana 010000, Kazakhstan.
Taraz City Multidisciplinary Hospital and Consulting and Diagnostic Center, Taraz 080000, Kazakhstan.
Cancers (Basel). 2025 Jun 6;17(12):1897. doi: 10.3390/cancers17121897.
Background High-grade gliomas (HGGs) are aggressive brain tumors with poor prognoses. Maximizing the extent of resection (EOR) is a critical surgical goal. Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) has been proposed to enhance tumor visualization and resection. MethodsWe retrospectively analyzed 141 patients with histologically confirmed HGGs who underwent either 5-ALA-guided ( = 71) or conventional white-light ( = 70) resection between 2018 and 2023. Propensity score matching and multivariate Cox regression models were used to assess the impact of 5-ALA on surgical outcomes and survival. Results: Gross total resection (GTR) was significantly more common in the 5-ALA group than the conventional white-light group (28.17% vs. 12.86%, = 0.0245). Kaplan-Meier analysis showed no statistically significant difference in overall survival between groups after matching (log-rank = 0.6371). However, patients with GTR had significantly improved survival compared to those with subtotal resection (log-rank = 0.0423). Multivariate Cox regression identified radiotherapy (HR = 0.291, 95% CI: 0.166-0.513, < 0.001), higher Karnofsky Performance Status (HR = 0.962, 95% CI: 0.942-0.982, = 0.0003), and GTR (HR = 0.476, 95% CI: 0.272-0.834, = 0.0091) as independent predictors of improved survival. 5-ALA usage was not an independent predictor (HR = 0.885, 95% CI: 0.554-1.413, = 0.612). Radiotherapy and chemotherapy were more frequently administered in the conventional white-light group ( = 0.0404 and = 0.0085, respectively). Conclusions 5-ALA fluorescence-guided surgery significantly increases the rate of gross total resection in high-grade glioma patients but does not independently confer a survival advantage. Survival outcomes are primarily influenced by the extent of resection, adjuvant therapy, and functional status. Integration of 5-ALA within a comprehensive oncological framework may enhance its clinical utility.
高级别胶质瘤（HGGs）是预后较差的侵袭性脑肿瘤。最大化切除范围（EOR）是关键的手术目标。已提出使用5-氨基乙酰丙酸（5-ALA）进行荧光引导手术以增强肿瘤可视化和切除效果。
我们回顾性分析了2018年至2023年间141例经组织学确诊为HGGs且接受了5-ALA引导切除（n = 71）或传统白光切除（n = 70）的患者。采用倾向评分匹配和多变量Cox回归模型来评估5-ALA对手术结果和生存的影响。
5-ALA组的全切除（GTR）明显比传统白光组更常见（28.17%对12.86%，P = 0.0245）。Kaplan-Meier分析显示匹配后两组间总生存无统计学显著差异（对数秩检验P = 0.6371）。然而，与次全切除患者相比，GTR患者的生存有显著改善（对数秩检验P = 0.0423）。多变量Cox回归确定放疗（HR = 0.291，95%CI：0.166 - 0.513，P < 0.001）、较高的卡诺夫斯基功能状态（HR = 0.962，95%CI：0.942 - 0.982，P = 0.0003）和GTR（HR = 0.476，95%CI：0.272 - 0.834，P = 0.0091）是生存改善的独立预测因素。5-ALA的使用不是独立预测因素（HR = 0.885，95%CI：0.554 - 1.413，P = 0.612）。传统白光组放疗和化疗的应用更频繁（分别为P = 0.0404和P = 0.0085）。
5-ALA荧光引导手术显著提高了高级别胶质瘤患者的全切除率，但并未独立带来生存优势。生存结果主要受切除范围、辅助治疗和功能状态的影响。将5-ALA整合到综合肿瘤学框架内可能会提高其临床效用。
