Neuro-oncological superiority of supratotal resection in lower-grade gliomas.

IF 16.4 1区 医学 Q1 CLINICAL NEUROLOGY
Alberto L Gallotti, Marco Rossi, Marco Conti Nibali, Tommaso Sciortino, Lorenzo G Gay, Guglielmo Puglisi, Antonella Leonetti, Francesco Bruno, Roberta Rudà, Riccardo Soffietti, Gabriella Cerri, Lorenzo Bello
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引用次数: 0

Abstract

Background: Supratotal-resection (SpTR) is a promising surgical strategy in lower-grade gliomas (LGGs). SpTR assessment, feasibility and distinctive features, as well as clinical benefit at first and second surgery and on overall survival must be better characterized. The critical percentage of resection exceeding FLAIR margins to obtain clinical benefit and its impact on long-term functional performance are also undefined.

Methods: Included were 704 patients with primary and 439 with recurrent LGGs seen between 2010 and 2019, who underwent resection with brain-mapping technique (BMT) aimed at achieving a SpTR without any "a-priori" selection. Extent-of-resection, evaluated on 3D-FLAIR-MR and categorized according to residual tumor and cavity volume, was associated with progression-free survival (PFS) and malignant(M)PFS at first and second surgery and overall survival by univariate, multivariate, and propensity-score analysis. Functional performance was assessed by neuropsychological (NPS) evaluation.

Results: SpTR evaluation requires volumetric assessment enhanced by brain deformation measurement in parietal tumors; SpTR rate accounts on average for 50.2% and 35.7% at first and second surgery is higher in grade-2, frontal, and temporal locations (at expenses of total resection [TR]). Compared to TR, SpTR reduces and postpones first and second recurrences in all molecular subtypes and grades, delays MPFS without difference in rate, and prolongs overall survival (OS). A degree of SpTR > 120% associates with the lowest recurrence risk. SpTR associates with the best NPS longitudinal course.

Conclusions: This study supports the feasibility of SpTR in LGGs, its benefit at first and second surgery regardless of molecular subtypes, and on OS, significantly reducing recurrence when SpTR > 120%; SpTR also associates with the best patients' functional outcome.

低度胶质瘤中鼻梁上切除术的神经肿瘤学优势。
背景:头上切除(SpTR)是治疗低级别胶质瘤(LGGs)的一种很有前途的手术策略。必须更好地描述SpTR的评估、可行性和特点,以及第一次和第二次手术的临床获益和总生存期。切除超过FLAIR边缘以获得临床益处的临界百分比及其对长期功能表现的影响也未明确。方法:纳入2010-2019年间的704例原发性和439例复发性lgg患者,这些患者采用脑定位技术(BMT)进行切除,旨在实现SpTR,而无需任何“先验”选择。通过3D-FLAIR-MR评估并根据残留肿瘤和腔体积分类的切除范围,与第一次和第二次手术的无进展生存期(PFS)和恶性(M)PFS以及单因素、多因素和倾向评分分析的总生存期相关。功能表现采用神经心理学- nps评价。结果:在顶壁肿瘤中,SpTR评估需要通过脑变形测量增强体积评估;第一次和第二次手术SpTR率分别为50.2%和35.7%,2级、额部和颞部更高(以全切除- tr为代价)。与TR相比,SpTR减少和推迟了所有分子亚型和分级的首次和第二次复发,延迟MPFS,但发生率没有差异,延长了总生存期。SpTR水平为120%与最低的复发风险相关。SpTR与最佳NPS纵向航向相关。结论:本研究支持SpTR在LGGs中的可行性,无论分子亚型如何,SpTR在第一次和第二次手术以及总生存率方面的益处,当SpTR达到120%时显著降低复发率;SpTR还与患者的最佳功能预后相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neuro-oncology
Neuro-oncology 医学-临床神经学
CiteScore
27.20
自引率
6.30%
发文量
1434
审稿时长
3-8 weeks
期刊介绍: Neuro-Oncology, the official journal of the Society for Neuro-Oncology, has been published monthly since January 2010. Affiliated with the Japan Society for Neuro-Oncology and the European Association of Neuro-Oncology, it is a global leader in the field. The journal is committed to swiftly disseminating high-quality information across all areas of neuro-oncology. It features peer-reviewed articles, reviews, symposia on various topics, abstracts from annual meetings, and updates from neuro-oncology societies worldwide.
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