肿瘤周围切除术对原发性胶质母细胞瘤患者生存的影响

IF 5.1 2区 医学 Q1 ONCOLOGY
Cancer Pub Date : 2025-07-24 DOI:10.1002/cncr.70016
Linda Y. Tang BS, David Botros MD, Anya A. Kim BS, Adham M. Khalafallah MD, Hayden Dux BS, Keiko Fox BS, Nauman Hussain BS, Yuncong Mao BS, Richard Pellegrino BS, Paarth Sharma BS, Calixto-Hope G. Lucas MD, A. Karim Ahmed MD, Christopher M. Jackson MD, Gary Gallia MD, PhD, Chetan Bettegowda MD, PhD, Jon Weingart MD, Henry Brem MD, Debraj Mukherjee MD, MPH
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引用次数: 0

摘要

目的胶质母细胞瘤(GBM)是最常见的原发性脑恶性肿瘤,其标准治疗包括对增强肿瘤进行最大切除。鉴于近年来对对比增强区域以外切除的兴趣,作者分析了肿瘤周围切除术(PTR)在原发性GBM中的作用。方法本研究纳入126例在三级保健学术医疗中心接受肿瘤周围切除术(PTR)的原发性GBM成年患者。收集患者特征和术前/术后肿瘤体积。对比增强肿瘤(EOR)切除程度的结果导向切点使用最大选择的秩统计来确定。采用多变量Cox比例风险(CPH)死亡模型。结果该队列平均年龄为60.7±11.3岁,中位总生存期(OS)/无进展生存期(PFS)为15.2/7.5个月。与EOR 92.1%相比,EOR 92.1%与OS增加相关(23.1 vs.14.0个月,p <;. 01)。54例(42%)患者接受PTR,其中28例(22%)患者PTR达到对比增强区外1.74 cm3。后一组的OS高于PTR<;1.74 cm3组(21.6 vs. 16.8个月,p <;0.01)。两组术后并发症发生率无明显差异。多变量CPH模型发现EOR为92.1% ~ 99%(风险比[HR], 0.30;置信区间[CI], 0.15-0.60, p <;.01), PTR >1.74 cm3 (HR, 0.27;CI, 0.13-0.56, p <;.01)与OS升高相关。术前T2-FLAIR容积>;192 cm3与较差的OS相关(HR, 3.18;CI, 1.17-8.61, p <;. 01)。结论:我们的研究结果表明,在对比增强的肿瘤边缘切除后,GBM的OS增加。在没有相关的术后缺陷增加的情况下,PTR >;1.74 cm3在特定病例中是有效和安全的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of peri-tumoral resection on survival in primary glioblastoma

Objective

Glioblastoma (GBM) is the most common primary brain malignancy, and standard treatment includes maximal resection of contrast-enhancing tumor. Given recent interest in resection beyond areas of contrast-enhancement, the authors analyzed the role of peri-tumoral resection (PTR) in primary GBM.

Methods

This study included 126 adult patients with primary GBM amenable to peri-tumoral resection (PTR) at a tertiary care academic medical center. Patient characteristics and pre/postoperative tumor volumes were collected. Outcome-oriented cut-points for extent of resection of contrast-enhancing tumor (EOR) were determined using maximally selected rank statistics. Multivariable Cox proportional hazards (CPH) model for death was performed.

Results

This cohort had mean age 60.7 ± 11.3 years and median overall survival (OS)/progression-free survival (PFS) 15.2/7.5 months. EOR >92.1% was associated with increased OS compared to <92.1% EOR (23.1 vs.14.0 months, p < .01). Fifty-four (42%) patients received PTR, of which 28 (22%) achieved PTR of >1.74 cm3 beyond the contrast-enhancing region. This latter group demonstrated greater OS than the PTR<1.74 cm3 group (21.6 vs. 16.8 months, p < 0.01). There was no significant difference in postoperative complications between groups. Multivariable CPH model found EOR 92.1%–99% (hazard ratio [HR], 0.30; confidence interval [CI], 0.15–0.60, p < .01) and PTR >1.74 cm3 (HR, 0.27; CI, 0.13–0.56, p < .01) were associated with increased OS. Preoperative T2-FLAIR volume >192 cm3 was associated with worse OS (HR, 3.18; CI, 1.17–8.61, p < .01).

Conclusion

Our results demonstrate increased OS in GBM with resection beyond contrast-enhancing tumor margins. With no associated increase in postoperative deficits, PTR >1.74 cm3 was both effective and safe in select cases.

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来源期刊
Cancer
Cancer 医学-肿瘤学
CiteScore
13.10
自引率
3.20%
发文量
480
审稿时长
2-3 weeks
期刊介绍: The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society. CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research
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