Daneyemez M, Gezen F, Canakçi Z, Kahraman S
Department of Neurosurgery, Gülhane Medical School, Ankara, Turkey.
Minim Invasive Neurosurg. 1998 Dec;41(4):209-13. doi: 10.1055/s-2008-1052044.
The treatment modalities for gliomas are still questioning and searching. We reviewed the effect of the extent of surgical resection and reoperation on the length and quality of survival in 152 consecutive patients who underwent operation for supratentorial gliomas at GATA Neurosurgery clinic between 1985 to 1995. Seventy-two patients (50%) had glioblastoma multiforme (GBM), and 48 patients (33%) had anaplastic astrocytoma (AA). Gross total resection was achieved in 70 cases (49%), subtotal resection was performed in 60 cases (42%), and biopsy was carried out in 14 cases (9%). Thirty-two patients were reoperated for recurrency and the median interval between the first operation and reoperation was 9.5 months in glioblastoma multiforme, and 11.7 months in anaplastic astrocytoma. The resection groups were compared for age, sex, preoperative and postoperative Karnofsky rating, tumor location, postoperative radiation therapy, and chemotherapy, and survival according to multivariate analysis. Preoperative Karnofsky rating and surgical resection type were the most important factors related to survival after operation or reoperation. The gross total resection group lived longer than the subtotal resection group by life table analysis. Median survival of GBM was 76 weeks in gross total resection group, and 33 months in AA group with total resection (p < 0.001). Preoperative Karnofsky scores had a statistically significant effect on the quality of life and survival after operation and reoperation in all cases (p = 0.005). Radical surgery and reoperation also improve quality and length of life in selective malignant supratentorial gliomas.
胶质瘤的治疗方式仍在探索和研究之中。我们回顾了1985年至1995年间在GATA神经外科诊所接受幕上胶质瘤手术的152例连续患者，手术切除范围和再次手术对其生存时间和生存质量的影响。72例患者（50%）患有多形性胶质母细胞瘤（GBM），48例患者（33%）患有间变性星形细胞瘤（AA）。70例（49%）实现了全切，60例（42%）进行了次全切，14例（9%）进行了活检。32例患者因复发接受了再次手术，多形性胶质母细胞瘤患者首次手术与再次手术的中位间隔时间为9.5个月，间变性星形细胞瘤患者为11.7个月。对切除组在年龄、性别、术前和术后卡诺夫斯基评分、肿瘤位置、术后放疗、化疗以及根据多因素分析的生存情况进行了比较。术前卡诺夫斯基评分和手术切除类型是与手术或再次手术后生存相关的最重要因素。通过寿命表分析，全切组的生存时间长于次全切组。GBM全切组的中位生存期为76周，AA全切组为33个月（p < 0.001）。术前卡诺夫斯基评分在所有病例中对手术和再次手术后的生活质量和生存均有统计学显著影响（p = 0.005）。根治性手术和再次手术也可改善部分幕上恶性胶质瘤患者的生活质量和生存时间。
