Young B, Oldfield E H, Markesbery W R, Haack D, Tibbs P A, McCombs P, Chin H W, Maruyama Y, Meacham W F
J Neurosurg. 1981 Dec;55(6):917-21. doi: 10.3171/jns.1981.55.6.0917.
The results of a second operation for tumor removal in 24 adult patients with supratentorial glioblastoma multiforme or anaplastic astrocytoma were analyzed. The median survival time after reoperation was 14 weeks. Five of the 24 patients lived 6 months or longer after reoperation. Only three of these patients maintained a Karnofsky rating (KR) of at least 60 for 6 months or longer after reoperation. Preoperative neurological status (KR) is the most significant determinant of survival after reoperation (p = 0.02). When the KR is at least 60, median survival after reoperation is 22 weeks. When the KR prior to reoperation is less than 60, median survival is 9 weeks. Only one of 13 patients with a KR of less than 60 prior to reoperation survived longer than 6 months after the second operation. The interval between first and second operation is significantly related to survival (p = 0.03), but when adjustment is made for the KR the interoperative interval is no longer significantly related to survival after the second operation (p = 0.39). Age, sex, and location of tumor were not significantly related to duration of survival. This study suggests that reoperation is most likely to produce the best result when the KR is at least 60 and the interval between operations is longer than 6 months. Using these criteria, one-third of the patients could be expected to survive with a KR of at least 60 for 6 months. The study indicates that reoperation should not be carried out when the KR is less than 60.
对24例患有幕上多形性胶质母细胞瘤或间变性星形细胞瘤的成年患者进行肿瘤切除二次手术的结果进行了分析。二次手术后的中位生存时间为14周。24例患者中有5例在二次手术后存活了6个月或更长时间。这些患者中只有3例在二次手术后6个月或更长时间内卡氏评分（KR）维持在至少60分。术前神经状态（KR）是二次手术后生存的最重要决定因素（p = 0.02）。当KR至少为60时，二次手术后的中位生存时间为22周。当二次手术前KR小于60时，中位生存时间为9周。二次手术前KR小于60的13例患者中只有1例在第二次手术后存活超过6个月。第一次和第二次手术之间的间隔与生存显著相关（p = 0.03），但在对KR进行调整后，手术间隔与第二次手术后的生存不再显著相关（p = 0.39）。年龄、性别和肿瘤位置与生存时间无显著相关性。本研究表明，当KR至少为60且手术间隔超过6个月时，二次手术最有可能产生最佳结果。使用这些标准，预计三分之一的患者在KR至少为60的情况下能存活6个月。该研究表明，当KR小于60时不应进行二次手术。
