线性回归模型预测接受伽玛刀放射外科治疗复发和残留颅咽管瘤患者的生存率和并发症发生率：743例肿瘤的荟萃分析

Linear regression models predict survival and complication rates in patients undergoing gamma knife radiosurgery for recurrent and residual craniopharyngiomas: a meta-analysis of 743 tumors.

作者信息

Pahwa Bhavya, Mahajan Sanah, Pahwa Nishtha, Panico Nicholas, Sheehan Jason P

机构信息

University College of Medical Sciences and GTB Hospital, Delhi, India.

Government Medical College, Jammu, India.

出版信息

J Neurooncol. 2025 Sep 15. doi: 10.1007/s11060-025-05196-6.

DOI:10.1007/s11060-025-05196-6

PMID:40952623

Abstract

PURPOSE

Craniopharyngiomas are clinically aggressive benign tumors that present a special challenge for clinicians due to high recurrence rates and post operative compilations. Surgical intervention alone poses many challenges and therefore, the use of radiotherapeutic adjuvant modalities has become common. This study aims to evaluate the effectiveness of gamma knife radiosurgery (GKRS) in the management of recurrent and residual craniopharyngiomas and identify the factors that could predict survival and complication rates.

METHODS

PubMed and Cochrane library were screened from inception until September 2024. Fixed effect models (I < 50%) and Random effects models (I > 50%) were created to study the pooled survival rates and complication rates. Linear Regression models were generated to identify the prognostic factors and F-test was used to check the significance of the models.

RESULTS

The meta-analysis included 743 tumors from nine selected studies. Estimated 3, 5 and 10 year OS rates were 96%, 93% and 85% respectively and estimated 3, 5 and 10 year PFS rates were 83%, 68% and 45% respectively. Estimated visual (VD) and endocrinological dysfunction (ED) rates were 5% and 4% respectively. Median marginal dose ≤ 13 Gy was the independent predictor of 3 year OS (β = 1.95, p = 0.02), while female patients (β=-0.52, p = 0.023), age (β=-0.36, p = 0.04) and median marginal dose ≤ 13 Gy (β = 2.55, p = 0.001) were found to be significant predictors of 5 year OS. F-test revealed that the models generated for 3 year and 5 year OS rates were significant with an excellent R values of 0.99 (p = 0.03) and 0.98 (p = 0.008) respectively. Age was the single significant predictor of VD (β=-0.80, p = 0.032) while tumor volume (β = 0.61, p = 0.035) and median marginal dose ≤ 13 Gy (β=-1.17, p = 0.039) were significant predictors of ED.

CONCLUSIONS

GKRS is an effective treatment modality for recurrent and residual craniopharyngiomas, providing comparable to improved survival rates to other modalities and significantly lower complication rates with a safe dose of ≤ 13 Gy.

摘要

目的

颅咽管瘤是临床上具有侵袭性的良性肿瘤，因其高复发率和术后并发症给临床医生带来了特殊挑战。仅手术干预就面临诸多挑战，因此，放射治疗辅助方式的应用已变得普遍。本研究旨在评估伽玛刀放射外科（GKRS）在复发性和残留性颅咽管瘤治疗中的有效性，并确定可预测生存率和并发症发生率的因素。

方法

从创刊至2024年9月对PubMed和Cochrane图书馆进行筛选。创建固定效应模型（I<50%）和随机效应模型（I>50%）来研究汇总生存率和并发症发生率。生成线性回归模型以识别预后因素，并使用F检验来检验模型的显著性。

结果

荟萃分析纳入了来自9项选定研究的743个肿瘤。估计的3年、5年和10年总生存率分别为96%、93%和85%，估计的3年、5年和10年无进展生存率分别为83%、68%和45%。估计的视力障碍（VD）和内分泌功能障碍（ED）发生率分别为5%和4%。中位边缘剂量≤13 Gy是3年总生存率的独立预测因素（β=1.95，p=0.02），而女性患者（β=-0.52，p=0.023）、年龄（β=-0.36，p=0.04）和中位边缘剂量≤13 Gy（β=2.55，p=0.001）被发现是5年总生存率的显著预测因素。F检验显示，为3年和5年总生存率生成的模型具有显著性，R值分别为0.99（p=0.03）和0.98（p=0.008），非常出色。年龄是视力障碍的唯一显著预测因素（β=-0.80，p=0.032），而肿瘤体积（β=0.61，p=0.035）和中位边缘剂量≤13 Gy（β=-1.17，p=0.039）是内分泌功能障碍的显著预测因素。