Introduction: Glioblastomas have poor prognosis despite aggressive treatment. Patterns of recurrence and overall survival (OS) can be very different. The population with complete resection having a so-called good prognosis can nevertheless present poor OS. Our purpose was to assess the OS and patterns of recurrence thanks to multimodal statistical maps in glioblastoma with large extent of resection (residue < 10 mL). Methods: adult patients presenting IDH wild-type glioblastoma between 2013 and 2019 were selected. Clinical data and MRI characteristics were collected. Preoperative, postoperative, and recurrence volumes were segmented and normalized in the MNI space to compute statistical maps. Log-rank test and Cox model were used to assess OS and prognosis factors. Results: 60 patients were included. Mean residual volume was 0.89 ± 2 mL. Median OS was 22.3 months (95% CI: (20–35)). Initial location in the corpus callosum was associated with low OS (317 vs. 783 days, HR = 0.46,p= 0.003). At recurrence, KPS > 90 and tumor volume < 10 mL were associated with higher OS (p=0.006 andp= 0.05). Tumor contact with the SVZ as well as multifocal recurrence did not show any impact on the OS. Conclusions: High OS can be obtained thanks to surgery with residual volume < 10 mL. Invasion of the corpus callosum at diagnosis is associated with a poor prognosis despite a large extent of resection. Results suggest that large resection near the SVZ might decrease its putative influence on OS.
引言：尽管采取积极治疗，胶质母细胞瘤的预后仍然较差。其复发模式和总生存期（OS）可能存在显著差异。即使实现肿瘤完全切除、被认为预后良好的患者群体，仍可能出现较差的OS。本研究旨在通过多模态统计图，评估大范围切除（残留体积<10 mL）的胶质母细胞瘤患者的OS及复发模式。方法：选取2013年至2019年间确诊为IDH野生型胶质母细胞瘤的成年患者。收集临床资料及MRI特征，对术前、术后及复发肿瘤体积进行分割并在MNI空间标准化，以构建统计图。采用对数秩检验和Cox模型评估OS及预后因素。结果：共纳入60例患者。平均残留体积为0.89±2 mL。中位OS为22.3个月（95% CI: 20-35）。诊断时肿瘤累及胼胝体与较低OS相关（317天 vs. 783天，HR=0.46，p=0.003）。复发时，KPS评分>90分且肿瘤体积<10 mL与较高OS相关（p=0.006和p=0.05）。肿瘤与脑室下区接触以及多灶性复发未显示对OS有显著影响。结论：通过残留体积<10 mL的手术切除可获得较高的OS。尽管实现大范围切除，诊断时胼胝体受侵犯仍提示预后不良。研究结果表明，在脑室下区附近进行广泛切除可能减弱其对OS的潜在影响。
肿瘤(癌症)患者之家