研究1：Outcomes in Reoperated Low-Grade Gliomas

 

　　標(biāo)題：低級別神經(jīng)膠質(zhì)瘤二次手術(shù)的效果

 

　　BACKGROUND:Low-grade gliomas(LGGs)comprise a diverse set of intrinsic brain tumors that correlate strongly with survival.Data on the effect of reoperation are sparse.

 

　　背景：低級別神經(jīng)膠質(zhì)瘤包括了一系列的與之生存率密切相關(guān)的顱內(nèi)腫瘤。關(guān)于二次手術(shù)效果的數(shù)據(jù)卻很少。

 

　　OBJECTIVE:To evaluate the effect of reoperation on patients with LGG.

 

　　目的：評價低級別神經(jīng)膠質(zhì)瘤（LGG）患者二次手術(shù)的效果。

 

　　METHODS:Fifty-two consecutive patients with reoperated LGGs treated at the University of Washington between 1986 and 2004 were identified and evaluated in a retrospective analysis.

 

　　方法：1986年至2004年在華盛頓大學(xué)接受二次手術(shù)的連續(xù)52名LGG患者被納入本次回顧性研究分析。

 

　　RESULTS:The average overall survival(OS)for this cohort was 12.95±0.96 years.The overall 10-year survival rate was 57%.The absence of any residual tumor at either the first or second operation was associated with significantly increased OS.Negative prognostic variables for OS included the use of upfront radiation and pathology at recurrence.The average overall progression-free survival to the first recurrence(PFS1)was 6.23±0.51 years.Positive prognostic factors for improved PFS1 included the use of upfront radiation therapy.Variables not associated with differences in PFS1 included the use of upfront chemotherapy,enhancement,pathology,extent of resection,the presence of residual tumor,and Karnofsky Performance Scale score＜80.The average overall progression-free survival to the second recurrence was 2.73±0.39 years.Pathology at recurrence was associated with significant differences in progression-free survival to the second recurrence,as was extent of resection at time of first recurrence,and Karnofsky Performance Scale score＜80.

 

　　結(jié)果：本組患者的平均總生存時長為12.95±0.96年。10年生存率57%。腫瘤切除干凈與一次或二次手術(shù)后總生存時長（OS）明顯增加相關(guān)。OS陰性預(yù)后變量包括前期放療和病理提示腫瘤復(fù)發(fā)。到一開始復(fù)發(fā)前的平均無進展生存期（PFS1）為6.23±0.51。提高PFS1的因素包括前期放療。與PFS1差異無關(guān)的變量包括前期放療的使用，強化，腫瘤病理分型、手術(shù)切除范圍、腫瘤殘余以及卡氏評分＜80分。二次復(fù)發(fā)的無進展生存期平均為2.73±0.39年。二次復(fù)發(fā)前的無進展生存期差異與復(fù)發(fā)的腫瘤病理類型、一次復(fù)發(fā)的切除范圍和卡氏評分＜80分明顯相關(guān)。

 

　　CONCLUSION:This is among the largest studies to assess variables associated with outcome in patients with reoperated LGG.Reresection appears to provide significant benefit,and extent of resection remains the strongest predictor of OS.

 

　　結(jié)論：這是評估LGG患者二次手術(shù)預(yù)后相關(guān)變量的較大研究之一。二次手術(shù)似乎有明顯的效果，手術(shù)切除的范圍仍然是OS的較強評估因素。

 

　　研究2：Impact of repeated operations for progressive low-grade gliomas

 

　　標(biāo)題：反復(fù)手術(shù)對進展性低級別膠質(zhì)瘤的影響

 

　　Background:Maximal,aggressive resection of diffuse low-grade gliomas(DLGG)is well established as the standard of care in neuro-oncology.The role of repeat resection for tumor progression is unclear.

 

　　背景:彌漫性低級別膠質(zhì)瘤(DLGG)的較大、侵襲性切除已被確立為神經(jīng)腫瘤的護理標(biāo)準(zhǔn)。重復(fù)切除對腫瘤進展的作用尚不清楚。

 

　　Objective:To assess the role of repeated operation for DLGG,and the effect on malignant transformation and survival.

 

　　目的:探討DLGG反復(fù)手術(shù)對其惡性轉(zhuǎn)化和生存的影響。

 

　　Methods:We conducted a historical cohort study in which all patients undergoing multiple resections of DLGG between the years 1995-2019 were evaluated for overall survival(OS)and time to transformation(TTT).We then compared the outcome of this group with that of a matched control group comprised of patients who underwent only one operation despite being eligible for repeat surgery at tumor progression,but had received non-surgical oncological therapy or declined additional treatment.

 

　　方法:我們進行了一項歷史隊列研究，評估了1995-2019年期間全部多次切除DLGG的患者的總生存期(OS)和轉(zhuǎn)化時間(TTT)。然后，我們將這一組的結(jié)果與一組匹配的對照組的結(jié)果進行了比較。對照組的患者在腫瘤進展時雖然有資格再次手術(shù)，但只接受了一次手術(shù)，但接受了非手術(shù)腫瘤治療或拒絕了額外的治療。

 

　　Results:Of 607 patients in our departmental DLGG database,93 patients underwent 2 or more surgeries and had sufficient follow-up and imaging data to be included in the study group.Thirty-eight patients were included in the matched control group.Early(less than 1 year)progression was associated with decreased survival and shorter TTT in the study group.Patients undergoing multiple resections had significantly longer TTT and OS compared to patients who underwent a single surgery.This effect was especially noted in patients who had radiological evidence of tumor transformation.

 

　　結(jié)果:在我科DLGG數(shù)據(jù)庫的607例患者中，有93例患者接受了2次或2次以上的手術(shù)，并有足夠的隨訪和影像學(xué)資料納入研究組。38例患者被納入匹配的對照組。在研究組中，早期(小于1年)進展與生存率降低和TTT縮短相關(guān)。與只接受一次手術(shù)的患者相比，接受多次手術(shù)的患者的TTT和OS明顯更長。這種效應(yīng)在有放射學(xué)證據(jù)的腫瘤轉(zhuǎn)化的患者中明顯。

 

　　Conclusions:Repeated resections of LGG are safe and offer survival benefit in select patients.Early progression following resection is associated with worse prognosis.Patients with evidence of radiological transformation may benefit the most from re-resection.

 

　　結(jié)論:反復(fù)切除LGG是順利的，并在特定的患者中提供生存優(yōu)勢。切除后早期進展與預(yù)后較差相關(guān)。有放射學(xué)轉(zhuǎn)變證據(jù)的患者可以從再次切除中獲益較大。