Background High-grade gliomas (HGGs) are aggressive brain tumors with poor prognoses. Maximizing the extent of resection (EOR) is a critical surgical goal. Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) has been proposed to enhance tumor visualization and resection. MethodsWe retrospectively analyzed 141 patients with histologically confirmed HGGs who underwent either 5-ALA-guided (n= 71) or conventional white-light (n= 70) resection between 2018 and 2023. Propensity score matching and multivariate Cox regression models were used to assess the impact of 5-ALA on surgical outcomes and survival. Results: Gross total resection (GTR) was significantly more common in the 5-ALA group than the conventional white-light group (28.17% vs. 12.86%,p= 0.0245). Kaplan–Meier analysis showed no statistically significant difference in overall survival between groups after matching (log-rankp= 0.6371). However, patients with GTR had significantly improved survival compared to those with subtotal resection (log-rankp= 0.0423). Multivariate Cox regression identified radiotherapy (HR = 0.291, 95% CI: 0.166–0.513,p< 0.001), higher Karnofsky Performance Status (HR = 0.962, 95% CI: 0.942–0.982,p= 0.0003), and GTR (HR = 0.476, 95% CI: 0.272–0.834,p= 0.0091) as independent predictors of improved survival. 5-ALA usage was not an independent predictor (HR = 0.885, 95% CI: 0.554–1.413,p= 0.612). Radiotherapy and chemotherapy were more frequently administered in the conventional white-light group (p= 0.0404 andp= 0.0085, respectively). Conclusions 5-ALA fluorescence-guided surgery significantly increases the rate of gross total resection in high-grade glioma patients but does not independently confer a survival advantage. Survival outcomes are primarily influenced by the extent of resection, adjuvant therapy, and functional status. Integration of 5-ALA within a comprehensive oncological framework may enhance its clinical utility.
背景：高级别胶质瘤（HGGs）是具有不良预后的侵袭性脑肿瘤。最大化切除范围（EOR）是手术的关键目标。使用5-氨基乙酰丙酸（5-ALA）的荧光引导手术被提出以增强肿瘤的可视化和切除。方法：我们回顾性分析了2018年至2023年间接受5-ALA引导切除（n=71）或传统白光切除（n=70）的141例经组织学证实为高级别胶质瘤的患者。采用倾向评分匹配和多变量Cox回归模型评估5-ALA对手术结果和生存率的影响。结果：5-ALA组中大体全切除（GTR）的发生率显著高于传统白光组（28.17% vs. 12.86%，p=0.0245）。Kaplan-Meier分析显示，匹配后两组间的总生存率无统计学显著差异（对数秩检验p=0.6371）。然而，与次全切除患者相比，实现GTR的患者生存率显著改善（对数秩检验p=0.0423）。多变量Cox回归分析确定放疗（HR = 0.291，95% CI：0.166–0.513，p < 0.001）、较高的卡氏功能状态评分（HR = 0.962，95% CI：0.942–0.982，p=0.0003）和GTR（HR = 0.476，95% CI：0.272–0.834，p=0.0091）是改善生存的独立预测因素。5-ALA的使用并非独立预测因素（HR = 0.885，95% CI：0.554–1.413，p=0.612）。传统白光组接受放疗和化疗的频率更高（分别为p=0.0404和p=0.0085）。结论：5-ALA荧光引导手术显著提高了高级别胶质瘤患者的大体全切除率，但并未独立带来生存优势。生存结果主要受切除范围、辅助治疗和功能状态的影响。将5-ALA整合到全面的肿瘤学治疗框架中可能会增强其临床效用。
肿瘤(癌症)患者之家