The Study Of Tumor Resection For The Prognosis Of Primary Glioblastoma

Section 1 The relationship between the prognosis of primary glioblastoma and the extent of resection and residual tumor volume on T1 contrast-enhencement seqence of MRIObjectiveGlioblastoma is the most common malignant tumor of central nervous system.The currently therapy is the comprehensive treatment in which surgical resection is the primary and most important part.However,does total resection of tumor better than partial resection of tumor on prognosis?If total resection can not be achieved,what surgical strategy should be achieved along with the condition that radiotherapy and chemotherapy evolve rapidly?The purpose of this study was to evaluate the relationship of surgical removal involving two factors which were extent of resection(EOR)and residual tumor volume(RTV)and the prognosis of primary glioblastoma.MethodThis study retrospectively analyzed the data of patients of primary glioblastoma,who were treated in Henan provincal people’s hospital from January 1,2007 to December 31,2013.According to the established criteria,292 patients were enrolled.For patients enrolled in the group,the related data was obtained from the clinical data and the death time and tumor recurrence time were determined.Image J software was used to determine the tumor volume before and after surgery,and the extent of tumor resection was obtained subsequently.SPSS17.0 statistical software was used for statistical analysis.Firstly,the general descriptive analysis was conducted.Then the survival difference was compared between total resection group and partly resection group,and the survival curve was drawn after that.Secondly,the relationship between EOR and RTV and progression free survival(PFS)and total survival(OS)was determined by univariable analysis and multivariable analysis,and the EOR and RTV thresholds which could significantly improve the pronosis of patients were determined.ResultsAmong 292 patients,177 was male and 115 was female.The median survival age was 52(45-59)years,the score of Karnofsky Performance Scale(KPS)was 80(80-90),the preoperative tumor volume was 31.82(17.82-50.70)cm~3.Fifteen patients(5.1%)were still alive at the end of the study.Total survival was 12.4(10.3-14.9)months,progression free survival was 8.55(6.9-11.0)months,extent of resection was0.96(0.85-1.00),and tumor residual volume was 1.32(0.00-4.23)cm~3.Patients with total resection of tumor had a statistically significant difference(χ~2value=83.168,P<0.001)comparing patients with partly resection of tumor.In univariable analysis,age,KPS score,postoperative adjuvant therapy,obvious cyst or necrosis,whether located in eloquent areas,proximity to ventricle,EOR and RTV were all associated with prognosis.In the multivarible analysis,RTV was related to DFS(HB=1.161,P=0.004)and OS(HB=1.222,P=0.022),while EOR was otherwise.RTV no less than 2.5 cm~3(χ~2value=28.73,P=0.008),EOR more than 85%(χ~2 value=44.758,P=0.009),can obviously improve patients’survival.ConclusionThe safe and maximal resection of tumor is the precondition for a longer survival of primary glioblastoma.If total resection can not be completed,efforts to obtain more than 85%of EOR and less than 2.5cm~3 of RTV can significantly benefit patients.RTV is an independent factor for prognosis of primary glioblastoma,while EOR maybe an dependent factor assosiated RTV.Section 2 The Relationship Between Extent of Tumor Resection and Residual Tumor Volume and Prognosis of Primary Glioblastoma on MRI FLAIR Sequence.Objective The relationship between the resection of T1 enhancement imaging(contrast-enhancement tumor,CET)on MRI and the prognosis of primary glioblastoma had been demonstrated.However,the resection of the edema zone around CET,namely fluid-attenuated inversion tumor(FT),can prolong the patient’s survival time? The purpose of this study was to identify the relationship between FT and the prognosis of primary glioblastoma.Method This study was a prospective study.The subjects were from the colony of patients with primay glioblastoma who underwent surgical resection at the people’s hospital of henan province between January 1,2014 and January 1,2016.Some factors related to prognosis were controlled in the course of the study.The follow-up period was uo to July 30,2017.Statistical analysis of the clinical data was performed,including general descriptive analysis,the difference of survival rate between this study and the first study,the related factors of overall survival in univariable and mulvariable analysis,the difference of survival rate between total resection and untotal resection group of CET and the survival rate of the total excision group,analysis of the threshold of tumor resection related to FT,and the difference of survival between total resection and partly resection group whose degree of FT resection greater than EOR threshold.Results A total of 85 patients were included.There were 54 males and 31 females.The mean age was 49.9±11.2 years.The score of Karnofsky Performance Scale(KPS)was 80(80-90).Preoperative CET tumor volume was 33.8(19.1-52.7)cm3.FT tumor volume was 51.5±32.0cm3.Four patients still survived in the end.Total survival time was 15.6(13.7-18.1)months.The PDF was 9.9(8.9-12.1)months.The EOR of CET was 1(0.87-1).The EOR of FT was 0.5(0.31-0.77).The residual volume of CET was 0(0-3.7)cm3.The residual volume of FT was 28.9 + 27.2cm3.The total resection of this study compared with the previous one was significantly statistical.Comparing survival of two groups,there was a statistically significant difference also.Factors related to OS included age,KPS score,MGMT promoter methylation status,CE-RTV,CE-EOR,F-RTV,F-EOR in univariable analysis;KPS score,MGMT promoter methylation status,CE-RTV,CE-EOR,F-RTV,F–EOR in multivariable analysis.The factors related to PFS included age,KPS score,MGMT promoter methylation status,ce-rtv,ce-eor,f-rtv,f-eor in univariable analysis,CE-RTV,F-RTV,F-EOR in multivariable analysis.The survival of total resection of the CET group compared with the partly resection group was statistically significant different.The survival of total resection of the FT group and partly resection group was statistically significant,too.The threshold of tumor resection of the total resection of FT group was 49%.Patinents in the total resection of FT did not better in survival comparing to patients who had a greater EOR than EOR threshold,while the χ2 value was 4.434 and P value was 0.055.Conclusion The use of advanced auxiliary means could enhence the tumor resection rate and improve the prognosis of patients.Residual of FT was an important factor affecting prognosis.Therefore,the enlargement of glioblastoma was necessary.But it seemed that the indiscriminate expansion of resection could not prolong the patient’s survival time,while TF was a referential resection.