Is a pretreatment radiological staging system feasible for suggesting the optimal extent of resection and predicting prognosis in glioblastoma? An observational study
Por:
Capellades, J, Puig, J, Domenech, S, Pujol, T, Oleaga, L, Camins, A, Majos, C, Diaz, R, de Quintana, C, Teixidor, P, Conesa, G, Plans, G, Gonzalez, J, Garcia-Balana, N, Velarde, JM, Balana, C
Publicada:
1 abr 2018
Resumen:
To assess the value of resection in glioblastoma based on pre-surgical tumor characteristics and a subsequent staging system. The lack of a staging system for glioblastoma hinders the analysis of treatment outcome. We classified 292 uniformly treated glioblastoma patients as stage I, II, or III based on tumor size, location, and eloquence and then analyzed the impact of the extent of resection. We classified 62% of patients as stage I, 25.3% as stage II, and 12.7% as stage III. Gross total resection (GTR) was performed mainly in stage I rather than stage II or III patients (79.2% vs. 14.6% vs. 6.3%; P < 0.001). Overall survival (OS) was 17.7, 14.6, and 10.8 months for stage I, II, and III patients, respectively (P = 0.005). Longer OS was significantly associated with greater extent of resection, younger age, KPS >= 70%, MGMT methylation, lower stage, and tumor <= 5 cm. In the subgroups of stage I (P = 0.04) and stage II (P < 0.001)-but not stage III-patients, GTR and partial resection (PR) were associated with longer OS. We constructed several multivariable models including different variables, and greater extent of resection, smaller tumor size, and MGMT methylation consistently emerged as independent markers of longer OS. This staging system provides a feasible tool for comparison of results. We confirmed the value of partial resection in stage I and II patients, in contrast to some reports suggesting that biopsy only is sufficient when gross total resection cannot be safely achieved.
Filiaciones:
Capellades, J:
Hosp del Mar, Radiol, Barcelona, Spain
Puig, J:
Hosp Univ Dr Josep Trueta, IDI, Biomed Res Inst IDIBGI, Imaging Res Unit, Girona, Spain
Domenech, S:
IDI, Radiol, Badalona, Spain
Pujol, T:
Hosp Clin Barcelona, Dept Radiol, Barcelona, Spain
Oleaga, L:
Hosp Clin Barcelona, Dept Radiol, Barcelona, Spain
Camins, A:
IDI, Radiol, Lhospitalet De Llobregat, Spain
Majos, C:
IDI, Radiol, Lhospitalet De Llobregat, Spain
Diaz, R:
IDI, Radiol, Badalona, Spain
de Quintana, C:
Hosp Santa Creu & Sant Pau, Neurosurg Dept, Barcelona, Spain
Teixidor, P:
Hosp Badalona Germans Trias & Pujol, Neurosurg Dept, Badalona, Spain
Conesa, G:
Hosp del Mar, Neurosurg Dept, Barcelona, Spain
Plans, G:
Bellvitge Hosp, Neurosurg Dept, Lhospitalet De Llobregat, Spain
Gonzalez, J:
Hosp Clin Barcelona, Neurosurg Dept, Barcelona, Spain
Garcia-Balana, N:
Inst Invest Germans Trias & Pujol IGTP, Badalona, Spain
Velarde, JM:
Inst Invest Germans Trias & Pujol IGTP, Badalona, Spain
Balana, C:
Hosp Badalona Germans Trias & Pujol, ICO, Med Oncol Serv, Ctra Canyet S-N, Barcelona 08916, Spain
|