Scerrati M, Roselli R, Iacoangeli M, Pompucci A, Rossi G F
Institute of Neurosurgery, Catholic University, Rome, Italy.
J Neurol Neurosurg Psychiatry. 1996 Sep;61(3):291-6. doi: 10.1136/jnnp.61.3.291.
To assess the role of surgery on survival of patients with grade II gliomas of the cerebral hemispheres.
One hundred and thirty one low grade hemispheric gliomas surgically treated (biopsied patients excluded) between 1978 and 1989 were retrospectively reviewed. Thalamic, basal ganglia, callosal, or ventricular location were not considered. All tumours were World Health Organisation (WHO) grade II gliomas: 42 fibrillary and 11 gemistocytic astrocytomas, 49 oligodendrogliomas, and 29 oligoastrocytomas. Patients' ages ranged from 14 to 63 (mean 32.9, median 34) years, Karnofsky performance from 0.50 to 0.90 (mean 80.7, median 80), and postsurgical follow up of the living patients from 24 to 190 (mean 97.02, median 93) months. Postoperative external radiotherapy was performed in 49 cases.
The overall survival probability at five years was 97.1%, at eight years 76.1%, and at 10 years 62.7% (median survival time 144 months). The impact on survival of the following variables was analysed: age (< 20, 21-40, and > 40 years), Karnofsky score (80-100, 70 < or = 70), histology, tumour extension (T1 < 3 cm, T2 3-5 cm, T3 > 5 cm maximum diameter), extent of surgical resection (S1 radical, S2 subtotal < 10% residual tumour, S3 partial-10%-50% residual tumour), and radiotherapy (either performed or not). A significant positive association with survival at univariate analysis was found for the age group < 20 years (P = 0.003), for total and subtotal surgical resections (S1 and S2; P < 0.001) and for the non-irradiated patients (P = 0.0049), whereas a shorter survival probability was noticed for gemistocytic astrocytomas (P < 0.001) and for tumour extension > 5 cm (T3; P = 0.0193). Karnofsky performance did not show any significant association with survival. The most relevant factor affecting survival at the multivariate analysis was the extent of surgical resection, which resulted as the only variable retaining a significant value (P = 0.001, risk factor = 2.20).
The data strongly support the role of a surgical removal as extensive as possible in the treatment of these tumours.
评估手术对大脑半球II级胶质瘤患者生存的作用。
回顾性分析1978年至1989年间手术治疗的131例低级别半球胶质瘤患者（排除活检患者）。未考虑丘脑、基底节、胼胝体或脑室部位。所有肿瘤均为世界卫生组织（WHO）II级胶质瘤：42例纤维型和11例肥胖型星形细胞瘤、49例少突胶质细胞瘤和29例少突星形细胞瘤。患者年龄范围为14至63岁（平均32.9岁，中位数34岁），卡氏评分0.50至0.90（平均80.7，中位数80），存活患者术后随访时间为24至190个月（平均97.02个月，中位数93个月）。49例患者术后接受了外照射放疗。
5年总生存概率为97.1%，8年为76.1%，10年为62.7%（中位生存时间144个月）。分析了以下变量对生存的影响：年龄（<20岁、21 - 40岁和>40岁）、卡氏评分（80 - 100、70≤70）、组织学、肿瘤大小（T1最大直径<3 cm、T2 3 - 5 cm、T3>5 cm）、手术切除范围（S1根治性、S2次全切除<10%残留肿瘤、S3部分切除 - 10% - 50%残留肿瘤）以及放疗（是否进行）。单因素分析发现，<20岁年龄组（P = 0.003）、全切除和次全切除（S1和S2；P < 0.001）以及未接受放疗的患者（P = 0.0049）与生存呈显著正相关，而肥胖型星形细胞瘤（P < 0.001）和肿瘤大小>5 cm（T3；P = 0.0193）患者的生存概率较低。卡氏评分与生存无显著相关性。多因素分析中影响生存的最相关因素是手术切除范围，这是唯一保留显著值的变量（P = 0.00(1)，危险因素 = 2.20）。
数据有力支持在这些肿瘤治疗中尽可能广泛地进行手术切除的作用。
