目的:术后MRI用于评估切除程度,监测治疗反应并检测高级别神经胶质瘤的进展。然而,符合接受的MRI随访指南,对管理/结果的影响尚不清楚。
方法:多中心,接受肿瘤治疗的确诊为WHO4级胶质瘤患者(2018年8月至2019年2月)的回顾性观察性队列研究.
目的:调查随访MRI监测实践和NICE建议的依从性(术后扫描<72h,MRI每3-6个月)和EANO(术后扫描<48h,MRI每3个月)。
结果:来自26个神经肿瘤中心的754名患者,中位年龄为63岁(IQR54-70),产量10,100(中位数,12.5/人,IQR5.2-19.4)人-月随访。在接受减瘤手术的患者中,大多数患者在手术后72小时内进行了术后MRI检查(78.0%,N=407/522),手术后48小时内(64.2%,N=335/522)。随后的随访MRI扫描的中位数为1(IQR0-4)。符合NICE和EANO建议的随访MRI为52.8%(N=398/754)和24.9%(N=188/754),分别。关于多变量Cox回归分析,NICE指南推荐的随访时间增加与OS延长相关(HR0.56,95%CI0.46-0.66,P<0.001),但非PFS(HR0.93,95%CI0.79-1.10,P=0.349)。根据EANO指南,在推荐的随访中花费的时间增加与更长的OS(HR0.54,95%CI0.45-0.63,P<0.001)相关,但与PFS无关(HR0.99,95%CI0.84-1.16,P=0.874)。
结论:胶质母细胞瘤的定期监测随访与较长的OS相关。需要进行前瞻性试验以确定常规或症状导向的MRI是否会影响预后。
OBJECTIVE: Post-operative MRI is used to assess extent of resection, monitor treatment response and detect progression in high-grade glioma. However, compliance with accepted guidelines for follow-up MRI, and impact on management/outcomes is unclear.
METHODS: Multi-center, retrospective observational cohort study of patients with confirmed WHO grade 4 glioma (August 2018-February 2019) receiving oncological treatment.
OBJECTIVE: investigate follow-up MRI surveillance practice and compliance with recommendations from NICE (Post-operative scan < 72h, MRI every 3-6 months) and EANO (Post-operative scan < 48h, MRI every 3 months).
RESULTS: There were 754 patients from 26 neuro-oncology centers with a median age of 63 years (IQR 54-70), yielding 10,100 (median, 12.5/person, IQR 5.2-19.4) person-months of follow-up. Of patients receiving debulking surgery, most patients had post-operative MRI within 72 h of surgery (78.0%, N = 407/522), and within 48 h of surgery (64.2%, N = 335/522). The median number of subsequent follow-up MRI scans was 1 (IQR 0-4). Compliance with NICE and EANO recommendations for follow-up MRI was 52.8% (N = 398/754) and 24.9% (N = 188/754), respectively. On multivariable Cox regression analysis, increased time spent in recommended follow-up according to NICE guidelines was associated with longer OS (HR 0.56, 95% CI 0.46-0.66, P < 0.001), but not PFS (HR 0.93, 95% CI 0.79-1.10, P = 0.349). Increased time spent in recommended follow-up according to EANO guidelines was associated with longer OS (HR 0.54, 95% CI 0.45-0.63, P < 0.001) but not PFS (HR 0.99, 95% CI 0.84-1.16, P = 0.874).
CONCLUSIONS: Regular surveillance follow-up for glioblastoma is associated with longer OS. Prospective trials are needed to determine whether regular or symptom-directed MRI influences outcomes.