Louise Deboeuf, Maximilien Riche, Henri Malaizé, Pauline Marijon, Karima Mokhtari, Franck Bielle, Suzanne Tran, Lucia Nichelli, Julian Jacob, Mehdi Touat, Khê Hoang-Xuan, Caroline Houillier, Florence Laigle-Donadey, David Reinecke, Maximilian I Ruge, Ahmed Idbaih, Bertrand Mathon
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引用次数: 0
摘要
目的:关于高龄脑肿瘤患者进行脑活检的收益风险比和治疗价值,目前尚缺乏相关数据。本研究旨在评估在年龄≥80岁的患者中进行立体定向活检的安全性,并评估该手术对后续治疗管理和总生存率(OS)的影响:作者回顾性分析了一家医疗机构15年间所有年龄≥80岁、因新确诊的脑内肿瘤而接受立体定向活检的患者的病历:在此期间,共进行了2350例立体定向脑活检,其中209例(8.9%)为208名年龄≥80岁的患者。96.2%的病例获得了组织学诊断。有 23 名患者(11.1%)的活检结果与疑似诊断结果不同。活检后,1.9%的患者出现持续性神经功能缺损。组织病理学诊断后,80.7%的病例接受了辅助治疗。只有卡诺夫斯基表现状态(KPS)评分≥70%才是接受完全辅助治疗的重要预测因素(OR 24.3,95% CI 7.0-84.1;P < 0.001)。活检后的中位OS为5.6个月(IQR为2.4-13.5个月)。4级胶质瘤、KPS评分<70%、MRI上肿瘤对比度增强预示着较短的OS。接受完整的一线辅助治疗预示着较长的生存期。在4级胶质瘤患者中,与MGMT启动子未甲基化的患者相比,O型6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)启动子甲基化的患者生存期明显延长(p < 0.001):结论:对高龄脑肿瘤患者进行立体定向活检具有较高的诊断率和良好的安全性,最终会影响患者的治疗管理和生存期。然而,考虑患者活检前的情况至关重要。具体来说,KPS评分≥70%被认为是该人群活检决策过程中的关键因素。
Safety and therapeutic impact of stereotactic biopsy in very elderly patients with brain tumors.
Objective: There is a lack of data regarding the benefit-risk ratio and therapeutic value of brain biopsy in very elderly patients with brain tumors. This study aimed to evaluate the safety of stereotactic biopsy in patients aged ≥ 80 years and assess the impact of the procedure on subsequent therapeutic management and overall survival (OS).
Methods: The authors retrospectively analyzed the medical records of all patients aged ≥ 80 years who underwent stereotactic biopsy for a newly diagnosed intracerebral tumor during a 15-year period at a single institution.
Results: During the period, 2350 stereotactic brain biopsies were performed, with 209 biopsies (8.9%) in 208 patients aged ≥ 80 years. Histological diagnosis was obtained in 96.2% of cases. Biopsy results differed from the suspected diagnosis in 23 patients (11.1%). After biopsy, 1.9% of the patients experienced persistent neurological deficit. After histopathological diagnosis, 80.7% of the cases received adjuvant treatment. Only a Karnofsky Performance Status (KPS) score ≥ 70% was a significant predictor of receiving complete adjuvant treatment (OR 24.3, 95% CI 7.0-84.1; p < 0.001). The median OS from biopsy was 5.6 months (IQR 2.4-13.5 months). Grade 4 glioma, KPS score < 70%, and tumor contrast enhancement on MRI predicted a shorter OS. Receiving complete first-line adjuvant therapy predicted a longer OS. In patients with grade 4 glioma, those exhibiting a methylated O 6-methylguanine-DNA methyltransferase (MGMT) promoter demonstrated significantly prolonged survival compared with patients with an unmethylated MGMT promoter (p < 0.001).
Conclusions: Stereotactic biopsy for very elderly patients with brain tumors has a high diagnostic yield and a favorable safety profile, ultimately impacting patients' therapeutic management and OS. Nonetheless, it is crucial to consider the patient's prebiopsy condition. Specifically, a KPS score ≥ 70% was identified as a key factor in the decision-making process for biopsy in this population.
期刊介绍:
The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.