幕上低级别星形细胞瘤：预后因素、去分化以及早期与晚期手术问题
Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery.
作者信息
van Veelen M L, Avezaat C J, Kros J M, van Putten W, Vecht C
机构信息
Department of Neurosurgery, University Hospital Rotterdam, Dr Daniel den Hoed Cancer Center, The Netherlands.
出版信息
J Neurol Neurosurg Psychiatry. 1998 May;64(5):581-7. doi: 10.1136/jnnp.64.5.581.
BACKGROUND
A retrospective study of patients with low grade astrocytoma was carried out because the best management of such patients remains controversial. Prognostic factors were identified by multivariate analysis. Special attention was paid to the effect of extent and timing of surgery.
METHODS
Ninety patients with low grade astrocytoma were studied. Seventy two patients had resective surgery, 15 had a diagnostic biopsy only, and three patients had resective surgery after initial biopsy.
RESULTS
Significant prognostic factors for survival were age, preoperative neurological condition, epilepsy as the single sign, extent of surgery, and histology. The extent of surgery was highly significant on univariate analysis (p=0.002); however, after correction for age and preoperative symptoms this was considerably reduced (p=0.04). A subgroup of 30 patients with epilepsy as their single presenting symptom was identified. Thirteen of these patients were treated immediately after diagnosis, whereas the other 17 patients were initially followed up and treated only after clinical or radiological progression. Survival in both groups was identical (63% survival rate after five years) and much better than survival for the whole group (27% survival rate after five years). Malignant dedifferentiation was observed in 25 (70%) of 36 patients who were reoperated, after a median period of 37 months. This period was 41 months for the subgroup of patients with epilepsy only and 28 months for the remaining patients.
CONCLUSIONS
Due to the retrospective nature of the study only restricted conclusions can be drawn. Low grade glioma with epilepsy as the single symptom has a much better prognosis than if accompanied by other symptoms. This prognosis is not influenced by the timing of surgery. It seems, therefore, safe to defer surgery until clinical or radiological progression in low grade glioma with epilepsy only.
背景
由于低级别星形细胞瘤患者的最佳治疗方案仍存在争议，因此对这类患者进行了一项回顾性研究。通过多变量分析确定了预后因素。特别关注手术范围和时机的影响。
方法
对90例低级别星形细胞瘤患者进行了研究。72例患者接受了切除手术，15例仅进行了诊断性活检，3例患者在初次活检后接受了切除手术。
结果
生存的显著预后因素包括年龄、术前神经状况、癫痫作为单一症状、手术范围和组织学。手术范围在单变量分析中具有高度显著性（p = 0.002）；然而，在对年龄和术前症状进行校正后，其显著性大幅降低（p = 0.04）。确定了一个以癫痫作为单一表现症状的30例患者亚组。其中13例患者在诊断后立即接受治疗，而其他17例患者最初进行随访，仅在临床或影像学进展后才接受治疗。两组的生存率相同（五年生存率为63%），且远高于整个组的生存率（五年生存率为27%）。在36例接受再次手术的患者中，有25例（70%）出现恶性去分化，中位时间为37个月。仅患有癫痫的患者亚组的这一时期为41个月，其余患者为28个月。
结论
由于该研究的回顾性性质，只能得出有限的结论。以癫痫作为单一症状的低级别胶质瘤的预后比伴有其他症状的情况要好得多。这种预后不受手术时机的影响。因此，对于仅患有癫痫的低级别胶质瘤，推迟手术直至临床或影像学进展似乎是安全的。
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