Purpose: To evaluate the role of tumor invasiveness profile in a homogeneous cohort of patients with newly diagnosed GBM (2021 WHO) that underwent SUPR by the RANO criteria, and to analyze its impact on survival outcomes. Methods: Patients with newly diagnosed, histologically confirmed glial tumors featuring contrast-enhancing lesions, who underwent surgery at our institution between January 2007 and January 2024, were retrospectively reviewed. Preoperative total tumor volume (T-TV), contrast-enhancing (CE), and infiltrative FLAIR tumor volume (FLAIR-TV) were calculated in cubic centimeters (cc) via manual segmentation. A neuronavigation system was utilized for surgery and lesions were molecularly evaluated following the 2021 WHO CNS tumor classification. Therefore, all patients were classified into extent of resection categories by the 2022 RANO-Resect classification. The tumor invasiveness profile was assessed using the proliferation/diffusion (ρ/D) ratio, calculated following Swanson’s method. A statistical analysis was finally performed. Results: Between 2007 and 2024, 410 adult patients with newly diagnosed gliomas were treated at our institution. Methylation of the MGMT promoter was statistically significant (HR = 0.43, 95% CI: 0.20–0.94,p= 0.035), indicating that methylation has a protective effect on survival. In multivariate analysis, only MGMT status was confirmed to be an independent predictor of overall survival (OS). MGMT methylation was significantly associated with improved progression-free survival (PFS) in moderately diffuse tumors (HR = 0.18, 95% CI: 0.03–0.95,p= 0.044). Conclusions: Using the proliferation–diffusion model to classify tumors, we identified moderately diffuse tumors with methylated MGMT status as a subgroup with significant survival benefits from SUPR.
目的：旨在评估肿瘤侵袭性特征在一组接受RANO标准定义的SUPR（超全切除）且新诊断为GBM（2021 WHO分类）的同质患者队列中的作用，并分析其对生存结局的影响。方法：回顾性分析了2007年1月至2024年1月期间在我院接受手术、经组织学确诊、具有对比增强病灶的新诊断胶质瘤患者。通过手动分割计算术前总肿瘤体积（T-TV）、对比增强肿瘤体积（CE）以及浸润性FLAIR肿瘤体积（FLAIR-TV），单位为立方厘米（cc）。手术使用神经导航系统，并依据2021年WHO中枢神经系统肿瘤分类对病灶进行分子评估。所有患者均根据2022年RANO-Resect分类标准进行切除程度分类。采用Swanson方法计算增殖/扩散（ρ/D）比值以评估肿瘤侵袭性特征。最后进行了统计分析。结果：2007年至2024年间，我院共治疗了410例新诊断的成人胶质瘤患者。MGMT启动子甲基化具有统计学显著性（HR = 0.43, 95% CI: 0.20–0.94, p = 0.035），表明甲基化对生存具有保护作用。在多变量分析中，仅MGMT状态被证实是总生存期（OS）的独立预测因子。在中度弥漫性肿瘤中，MGMT甲基化与改善的无进展生存期（PFS）显著相关（HR = 0.18, 95% CI: 0.03–0.95, p = 0.044）。结论：通过使用增殖-扩散模型对肿瘤进行分类，我们确定了MGMT甲基化的中度弥漫性肿瘤作为一个亚组，能够从SUPR中获得显著的生存获益。
Proliferation-Diffusion Modeling in Glioblastoma: Impact of Supramaximal Resection on Survival
肿瘤(癌症)患者之家