优化复发性胶质母细胞瘤的挽救治疗:整合韩国放射肿瘤学组遗传生物标志物的多中心研究》(21-02)。

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY Neurosurgery Pub Date : 2024-09-01 Epub Date: 2024-03-21 DOI:10.1227/neu.0000000000002903
Dowook Kim, Joo Ho Lee, Nalee Kim, Do Hoon Lim, Jin Ho Song, Chang-Ok Suh, Chan Woo Wee, In Ah Kim
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引用次数: 0

摘要

背景和目的:很少有研究使用真实世界的患者数据来比较复发性胶质母细胞瘤(rGBM)的总体治疗模式和生存结果。本研究旨在通过结合生物标志物分析,根据rGBM的治疗策略评估进展后生存率(PPS):我们评估了468例接受标准替莫唑胺化疗的rGBM成人患者。在异柠檬酸脱氢酶野生型rGBM患者(n = 439)中,我们使用生存概率分析评估了预测因素对PPS的影响。我们确定了哪些患者可在首次进展期间从再照射(re-RT)中获益:最佳支持治疗组(82 人)、手术组(有/无辅助治疗,112 人)、单纯化疗组(170 人)和再放疗组(有/无化疗,75 人)的中位生存期分别为 3.4 个月、13.8 个月、6.6 个月和 10.0 个月。对队列进行倾向得分匹配分析后发现,手术组和再RT组的PPS均明显优于单纯化疗组;但手术组和再RT组的PPS无明显差异。在手术亚组中,手术联合化疗组(P = 0.024)和手术联合放疗(化疗)组(P = 0.039)的 PPS 明显优于单纯手术组。在不手术亚组中,与单纯化疗相比,放疗(化疗)可明显改善PPS(P = .047)。细胞周期蛋白依赖性激酶抑制剂2A/B的同基因缺失以及其他临床因素(表现评分和无进展间隔)与再RT生存获益显著相关:手术联合放疗(化疗)可使rGBM患者获得最佳生存效果。对于首次复发的rGBM患者,也应考虑再次放疗。此外,本研究还发现了一种特殊的基因生物标志物和临床因素,它们可能会提高再放疗的生存率。
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Optimizing Recurrent Glioblastoma Salvage Treatment: A Multicenter Study Integrating Genetic Biomarkers From the Korean Radiation Oncology Group (21-02).

Background and objectives: Few studies have used real-world patient data to compare overall treatment patterns and survival outcomes for recurrent glioblastoma (rGBM). This study aimed to evaluate postprogression survival (PPS) according to the treatment strategy for rGBM by incorporating biomarker analysis.

Methods: We assessed 468 adult patients with rGBM who underwent standard temozolomide-based chemoradiation. The impact of predictors on PPS was evaluated in patients with isocitrate dehydrogenase wild-type rGBM (n = 439) using survival probability analysis. We identified patients who would benefit from reirradiation (re-RT) during the first progression.

Results: Median PPS was 3.4, 13.8, 6.6, and 10.0 months in the best supportive care (n = 82), surgery (with/without adjuvant therapy, n = 112), chemotherapy alone (n = 170), and re-RT (with/without chemotherapy, n = 75) groups, respectively. After propensity score matching analysis of the cohort, both the surgery and re-RT groups had a significantly better PPS than the chemotherapy-only group; however, no significant difference was observed in PPS between the surgery and re-RT groups. In the surgery subgroup, surgery with chemotherapy ( P = .024) and surgery with radio(chemo)therapy ( P = .039) showed significantly improved PPS compared with surgery alone. In the no-surgery subgroup, radio(chemo)therapy showed significantly improved PPS compared with chemotherapy alone ( P = .047). Homozygous deletion of cyclin-dependent kinase inhibitor 2A/B, along with other clinical factors (performance score and progression-free interval), was significantly associated with the re-RT survival benefit.

Conclusion: Surgery combined with radio(chemo)therapy resulted in the best survival outcomes for rGBM. re-RT should also be considered for patients with rGBM at first recurrence. Furthermore, this study identified a specific genetic biomarker and clinical factors that may enhance the survival benefit of re-RT.

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来源期刊
Neurosurgery
Neurosurgery 医学-临床神经学
CiteScore
8.20
自引率
6.20%
发文量
898
审稿时长
2-4 weeks
期刊介绍: Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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