Abstract：
OBJECTIVE: It remains unclear whether combining carmustine wafer (CW) implantation with the standard treatment for adult-type diffuse gliomas is safe and has a prognostic impact. This study aimed to investigate the prognostic value and safety of CW implantation.
METHODS: Adult patients with IDH-wild-type and -mutant gliomas, grades 3-4 treated with surgical resection, radiotherapy, and temozolomide chemotherapy between 2013 and 2023 were surveyed. CWs were implanted except in cases of intraoperative wide ventricle opening or marked preoperative brain swelling. For survival analyses, a case-matched dataset based on propensity score matching (PSM), including multiple factors (patient background, diagnosis, and extent of resection) was generated. Progression-free survival (PFS), overall survival (OS), and frequency of complications of CW implantation (brain edema, infection, and cerebrospinal fluid leakage) were compared between the CW and non-use groups.
RESULTS: In total, 127 patients (75 in the CW use group and 52 in the non-use group) were enrolled. Regardless of stratification, no significant differences in PFS and OS were observed between the CW use and non-use groups. The frequency of postoperative brain edema was significantly higher in the CW use group than in the non-use group. An adjusted dataset containing 41 patients in the CW use and nonuse groups was generated. Even after PSM, CW implantation had no prognostic effect.
CONCLUSIONS: CW implantation with standard treatment demonstrated little beneficial effect for the present strategy of CW use.
METHODS: Adult patients with IDH-wild-type and -mutant gliomas, grades 3-4 treated with surgical resection, radiotherapy, and temozolomide chemotherapy between 2013 and 2023 were surveyed. CWs were implanted except in cases of intraoperative wide ventricle opening or marked preoperative brain swelling. For survival analyses, a case-matched dataset based on propensity score matching (PSM), including multiple factors (patient background, diagnosis, and extent of resection) was generated. Progression-free survival (PFS), overall survival (OS), and frequency of complications of CW implantation (brain edema, infection, and cerebrospinal fluid leakage) were compared between the CW and non-use groups.
RESULTS: In total, 127 patients (75 in the CW use group and 52 in the non-use group) were enrolled. Regardless of stratification, no significant differences in PFS and OS were observed between the CW use and non-use groups. The frequency of postoperative brain edema was significantly higher in the CW use group than in the non-use group. An adjusted dataset containing 41 patients in the CW use and nonuse groups was generated. Even after PSM, CW implantation had no prognostic effect.
CONCLUSIONS: CW implantation with standard treatment demonstrated little beneficial effect for the present strategy of CW use.
摘要：
目的：目前尚不清楚卡莫司汀片（CW）植入与成人弥漫性神经胶质瘤的标准治疗相结合是否安全且具有预后影响。本研究旨在探讨CW植入的预后价值和安全性。
方法：患有IDH野生型和突变型胶质瘤的成年患者，3-4级手术切除治疗，放射治疗,调查了2013年至2023年之间的替莫唑胺化疗。除了术中宽脑室开放或术前脑肿胀的情况外，植入了CW。对于生存分析，基于倾向得分匹配(PSM)的病例匹配数据集，包括多个因素(患者背景，诊断,和切除程度）。无进展生存期（PFS），总生存期（OS），和CW植入并发症的频率（脑水肿，感染,和脑脊液漏）在CW和未使用组之间进行比较。
结果：总计，纳入127例患者（CW使用组75例，非使用组52例）。不管分层，CW使用组和不使用组之间的PFS和OS无显著差异.CW使用组术后脑水肿的频率明显高于未使用组。生成了一个调整后的数据集，其中包含使用和不使用CW组的41名患者。即使在PSM之后,CW植入对预后无影响。
结论：使用标准治疗的CW植入对目前的CW使用策略几乎没有益处。
方法：患有IDH野生型和突变型胶质瘤的成年患者，3-4级手术切除治疗，放射治疗,调查了2013年至2023年之间的替莫唑胺化疗。除了术中宽脑室开放或术前脑肿胀的情况外，植入了CW。对于生存分析，基于倾向得分匹配(PSM)的病例匹配数据集，包括多个因素(患者背景，诊断,和切除程度）。无进展生存期（PFS），总生存期（OS），和CW植入并发症的频率（脑水肿，感染,和脑脊液漏）在CW和未使用组之间进行比较。
结果：总计，纳入127例患者（CW使用组75例，非使用组52例）。不管分层，CW使用组和不使用组之间的PFS和OS无显著差异.CW使用组术后脑水肿的频率明显高于未使用组。生成了一个调整后的数据集，其中包含使用和不使用CW组的41名患者。即使在PSM之后,CW植入对预后无影响。
结论：使用标准治疗的CW植入对目前的CW使用策略几乎没有益处。
