Pseudoprogression in glioblastoma patients: the impact of extent of resection

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• 作者：Hun Ho Park ; Tae Hoon Roh ; Seok Gu Kang ; Eui Hyun Kim…
• 关键词：Extent of resection ; Glioblastoma ; MGMT promoter status ; Pseudoprogression
• 刊名：Journal of Neuro-Oncology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：126
• 期：3
• 页码：559-566
• 全文大小：451 KB
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• 作者单位：Hun Ho Park (1) (6)
  Tae Hoon Roh (1) (6)
  Seok Gu Kang (1) (6) (7)
  Eui Hyun Kim (1) (6) (7)
  Chang-Ki Hong (1)
  Se Hoon Kim (2) (6) (7)
  Sung Soo Ahn (3) (6)
  Seung Koo Lee (3) (6)
  Hye Jin Choi (4) (6)
  Jaeho Cho (5) (6)
  Sun Ho Kim (1) (6) (7)
  Kyu-Sung Lee (1) (6) (7)
  Chang-Ok Suh (5) (6) (8)
  Jong Hee Chang (1) (6) (7) (9)
  
  1. Departments of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
  6. Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea
  7. Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
  2. Departments of Pathology, Yonsei University College of Medicine, Seoul, Korea
  3. Departments of Radiology, Yonsei University College of Medicine, Seoul, Korea
  4. Departments of Medical Oncology, Yonsei University College of Medicine, Seoul, Korea
  5. Departments of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
  8. Department of Radiation Oncology, Yonsei University Health System, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
  9. Department of Neurosurgery, Yonsei University Health System, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korean
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Oncology
  
• 出版者：Springer Netherlands
• ISSN：1573-7373

文摘

Pseudoprogression (psPD) is a radiation-induced toxicity that has substantial neurological consequence in glioblastoma (GBM) patients. MGMT promoter methylation has been shown to be an important prognostic factor of psPD, but the significance of extent of resection (EOR) remains unclear. We performed a retrospective analysis on newly diagnosed GBM patients with assessable MGMT promoter status who underwent the Stupp protocol. EOR was grouped into gross total resection (GTR), subtotal resection (STR), partial resection (PR) and stereotactic biopsy. Contrast enhancing lesion enlargement was classified as psPD or non-psPD. Among a total of 101 patients, GTR, STR, PR and stereotactic biopsy was performed in 57 (56.4 %), 34 (33.7 %), 9 (8.9 %) and 1 patient (1 %), respectively. Follow-up imaging at the end of Stupp protocol classified 45 patients (44.6 %) as psPD and 56 (55.4 %) as non-psPD. psPD was observed in 24 (61.5 %) of 39 patients with methylated MGMT promoter and 21 (33.9 %) of 62 patients with unmethylated MGMT promoter (p < 0.01). psPD was documented in 17 (29.8 %), 19 (55.9 %), 8 (88.9 %) and 1 (100 %) patient with GTR, STR, PR and stereotactic biopsy (p < 0.01), respectively. On multivariate analysis MGMT promoter status (OR 3.36, 95 % CI 1.36–8.34) and EOR (OR 4.12, 95 % CI 1.71–9.91) were independent predictors of psPD. A Cox proportional hazards model showed that MGMT status (HR 2.51, p < 0.01) and EOR (HR 2.99, p < 0.01) significantly influenced survival. MGMT status and EOR have a significant impact on psPD. GTR can reduce the side effects of psPD and prolong survival. Keywords Extent of resection Glioblastoma MGMT promoter status Pseudoprogression