残留肿瘤的定量评估是甲基化胶质母细胞瘤患者在接受CCNU/TMZ放化疗后生存期的一个强有力的独立预测指标。

IF 16.4 1区 医学 Q1 CLINICAL NEUROLOGY Neuro-oncology Pub Date : 2024-10-01 DOI:10.1093/neuonc/noae205
Thomas Zeyen, Laura Böhm, Daniel Paech, Niklas Schäfer, Theophilos Tzaridis, Cathrina Duffy, Louisa Nitsch, Matthias Schneider, Anna-Laura Potthoff, Javen Lennard Schneider-Rothhaar, Joachim Peter Steinbach, Peter Hau, Thomas Kowalski, Clemens Seidel, Dietmar Krex, Oliver Grauer, Roland Goldbrunner, Pia Susan Zeiner, Ghazaleh Tabatabai, Norbert Galldiks, Walter Stummer, Elke Hattingen, Martin Glas, Eleni Gkika, Hartmut Vatter, Alexander Radbruch, Ulrich Herrlinger, Johannes Weller, Christina Schaub
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引用次数: 0

摘要

背景:最大程度的肿瘤切除可提高胶质母细胞瘤患者的总生存率(OS)。切除范围(EOR)历来是二分法。最近,RANO resect 小组提出了对按照 Stupp's 方案治疗的患者进行基于容积测量的 EOR 评估标准。本研究的目的是:(1) 探讨EOR在接受洛莫司汀(CCNU)/替莫唑胺(TMZ)联合化疗患者中的预后价值;(2) 分析二元EOR评估与容积评估相比的预后表现。采用单变量和多变量Cox回归分析以及双侧对数秩检验,测量首次切除术后残留的造影剂增强(CE)肿瘤体积,并分析其对OS和PFS的影响。根据RANO切除组提出的标准,将患者分为RTV≤1 cm³、>1 cm³-≤5 cm³和>5 cm³:结果:OS的延长与年龄有关:在接受 CCNU/TMZ 放射化疗的胶质母细胞瘤患者中,低 RTV 与生存期延长有关。这项研究表明,最近提出的 RANO resect 标准适用于这一亚组患者。
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Quantitative assessment of residual tumor is a strong and independent predictor of survival in methylated glioblastoma following radiochemotherapy with CCNU/TMZ.

Background: Maximum tumor resection improves overall survival (OS) in patients with glioblastoma. The extent of resection (EOR) is historically dichotomized. The RANO resect group recently proposed criteria for volumetry-based EOR assessment in patients that were treated according to Stupp´s protocol. The purpose of this study was (1) to investigate the prognostic value of EOR in patients receiving combined chemotherapy with lomustine (CCNU)/temozolomide (TMZ), and (2) to analyse the prognostic performance of binary EOR assessment compared to volumetric assessment.

Methods: 78 patients with newly diagnosed MGMT-methylated GBM undergoing tumor resection followed by radiochemotherapy with CCNU/TMZ were included in this study. Residual contrast-enhancing (CE) tumor volume after the first resection was measured and its influence on OS and PFS was analysed using uni- and multivariable Cox regression analysis as well as two-sided log rank test. Patients were divided into RTV ≤1 cm³, >1 cm³ - ≤5 cm³ and >5 cm³ following the proposed criteria of the RANO resect group.

Results: Prolonged OS was associated with age <60 years, low RTV, and gross total resection (GTR). Residual tumor volume (RTV) had a superior prognostic value compared to binary EOR assessment. Patients with total or near total resection of CE tumor (≤1 cm³ RTV) showed prolonged OS (median 54.4 months, 95% CI 46.94-not reached), with a 5-year survival rate of 49%.

Conclusion: Low RTV is associated with increased survival in glioblastoma patients undergoing radiochemotherapy with CCNU/TMZ. This study demonstrates the applicability of the recently proposed RANO resect criteria in this subgroup of patients.

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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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