2016
Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis
THOMPSON, Eric M., Thomas HIELSCHER, Eric BOUFFET, Marc REMKE, Betty LUU et. al.Základní údaje
Originální název
Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis
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THOMPSON, Eric M. (124 Kanada), Thomas HIELSCHER (276 Německo), Eric BOUFFET (124 Kanada), Marc REMKE (124 Kanada), Betty LUU (124 Kanada), Sridharan GURURANGAN (840 Spojené státy), Roger E. MCLENDON (840 Spojené státy), Darell D. BIGNER (840 Spojené státy), Eric S. LIPP (840 Spojené státy), Sebastien PERREAULT (840 Spojené státy), Yoon-Jae CHO (840 Spojené státy), Gerald GRANT (840 Spojené státy), Seung-Ki KIM (410 Korejská republika), Ji Yeoun LEE (410 Korejská republika), Amulya A Nageswara RAO (840 Spojené státy), Caterina GIANNINI (840 Spojené státy), Kay Ka Wai LI (156 Čína), Ho-Keung NG (156 Čína), Yu YAO (156 Čína), Toshihiro KUMABE (392 Japonsko), Teiji TOMINAGA (392 Japonsko), Wieslawa A. GRAJKOWSKA (616 Polsko), Marta PEREK-POLNIK (616 Polsko), David C. Y. LOW (702 Singapur), Wan Tew SEOW (702 Singapur), Kenneth T. E. CHANG (702 Singapur), Jaume MORA (724 Španělsko), Ian F. POLLACK (840 Spojené státy), Ronald L. HAMILTON (840 Spojené státy), Sarah LEARY (840 Spojené státy), Andrew S. MOORE (36 Austrálie), Wendy J. INGRAM (36 Austrálie), Andrew R. HALLAHAN (36 Austrálie), Anne JOUVET (250 Francie), Michelle FÈVRE-MONTANGE (250 Francie), Alexandre VASILJEVIC (250 Francie), Cecile FAURE-CONTER (250 Francie), Tomoko SHOFUDA (392 Japonsko), Naoki KAGAWA (392 Japonsko), Naoya HASHIMOTO (392 Japonsko), Nada JABADO (124 Kanada), Alexander G. WEIL (124 Kanada), Tenzin GAYDEN (124 Kanada), Takafumi WATAYA (392 Japonsko), Tarek SHALABY (756 Švýcarsko), Michael GROTZER (756 Švýcarsko), Karel ZITTERBART (203 Česká republika, domácí), Jaroslav ŠTĚRBA (203 Česká republika, garant, domácí), Leoš KŘEN (203 Česká republika, domácí), Tibor HORTOBÁGYI (348 Maďarsko), Almos KLEKNER (348 Maďarsko), Bognár LÁSZLÓ (348 Maďarsko), Tímea PÓCZA (348 Maďarsko), Peter HAUSER (348 Maďarsko), Ulrich SCHÜLLER (276 Německo), Shin JUNG (410 Korejská republika), Woo-Youl JANG (410 Korejská republika), Pim J. FRENCH (528 Nizozemské království), Johan M. KROS (528 Nizozemské království), Marie-Lise C. van VEELEN (528 Nizozemské království), Luca MASSIMI (380 Itálie), Jeffrey R. LEONARD (840 Spojené státy), Joshua B. RUBIN (840 Spojené státy), Rajeev VIBHAKAR (840 Spojené státy), Lola B. CHAMBLESS (840 Spojené státy), Michael K. COOPER (840 Spojené státy), Reid C. THOMPSON (840 Spojené státy), Claudia C. FARIA (620 Portugalsko), Alice CARVALHO (620 Portugalsko), Sofia NUNES (620 Portugalsko), José PIMENTEL (620 Portugalsko), Xing FAN (840 Spojené státy), Karin M. MURASZKO (840 Spojené státy), Enrique LÓPEZ-AGUILAR (484 Mexiko), David LYDEN (840 Spojené státy), Livia GARZIA (124 Kanada), David J. H. SHIH (124 Kanada), Noriyuki KIJIMA (124 Kanada), Christian SCHNEIDER (124 Kanada), Jennifer ADAMSKI (124 Kanada), Paul A. NORTHCOTT (276 Německo), Marcel KOOL (276 Německo), David T.W. JONES (276 Německo), Jennifer A. CHAN (124 Kanada), Ana NIKOLIC (124 Kanada), Maria Luisa GARRE (380 Itálie), Erwin G. Van MEIR (840 Spojené státy), Satoru OSUKA (840 Spojené státy), Jeffrey J. OLSON (840 Spojené státy), Arman JAHANGIRI (840 Spojené státy), Brandyn A. CASTRO (840 Spojené státy), Nalin GUPTA (840 Spojené státy), William A. WEISS (840 Spojené státy), Iska MOXON-EMRE (124 Kanada), Donald J. MABBOTT (124 Kanada), Alvaro LASSALETTA (124 Kanada), Cynthia E. HAWKINS (124 Kanada), Uri TABORI (124 Kanada), James DRAKE (124 Kanada), Abhaya KULKARNI (124 Kanada), Peter DIRKS (124 Kanada), James T. RUTKA (124 Kanada), Andrey KORSHUNOV (276 Německo), Stefan M. PFISTER (276 Německo), Roger J. PACKER (840 Spojené státy), Vijay RAMASWAMY (124 Kanada) a Michael D. TAYLOR (124 Kanada)
Vydání
Lancet Oncology, New York, Elsevier Science INC, 2016, 1470-2045
Další údaje
Jazyk
angličtina
Typ výsledku
Článek v odborném periodiku
Obor
30200 3.2 Clinical medicine
Stát vydavatele
Spojené státy
Utajení
není předmětem státního či obchodního tajemství
Impakt faktor
Impact factor: 33.900
Kód RIV
RIV/00216224:14110/16:00092577
Organizační jednotka
Lékařská fakulta
UT WoS
000373497600049
Klíčová slova anglicky
POSTERIOR-FOSSA TUMORS; CHILDRENS CANCER GROUP; RISK MEDULLOBLASTOMA; RADIATION-THERAPY; ADJUVANT CHEMOTHERAPY; RANDOMIZED-TRIAL; PHASE-III; ONCOLOGY; CHILDHOOD; PATTERNS
Štítky
Příznaky
Mezinárodní význam, Recenzováno
Změněno: 10. 1. 2017 11:26, Ing. Mgr. Věra Pospíšilíková
Anotace
V originále
Background Patients with incomplete surgical resection of medulloblastoma are controversially regarded as having a marker of high-risk disease, which leads to patients undergoing aggressive surgical resections, so-called second-look surgeries, and intensified chemoradiotherapy. All previous studies assessing the clinical importance of extent of resection have not accounted for molecular subgroup. We analysed the prognostic value of extent of resection in a subgroup-specific manner. Methods We retrospectively identified patients who had a histological diagnosis of medulloblastoma and complete data about extent of resection and survival from centres participating in the Medulloblastoma Advanced Genomics International Consortium. We collected from resections done between April, 1997, and February, 2013, at 35 international institutions. We established medulloblastoma subgroup affiliation by gene expression profiling on frozen or formalin-fixed paraffin-embedded tissues. We classified extent of resection on the basis of postoperative imaging as gross total resection (no residual tumour), near-total resection (< 1.5 cm(2) tumour remaining), or sub-total resection (>= 1.5 cm(2) tumour remaining). We did multivariable analyses of overall survival and progression-free survival using the variables molecular subgroup (WNT, SHH, group 4, and group 3), age (< 3 vs >= 3 years old), metastatic status (metastases vs no metastases), geographical location of therapy (North America/Australia vs rest of the world), receipt of chemotherapy (yes vs no) and receipt of craniospinal irradiation (< 30 Gy or > 30 Gy vs no craniospinal irradiation). The primary analysis outcome was the effect of extent of resection by molecular subgroup and the effects of other clinical variables on overall and progression-free survival. Findings We included 787 patients with medulloblastoma (86 with WNT tumours, 242 with SHH tumours, 163 with group 3 tumours, and 296 with group 4 tumours) in our multivariable Cox models of progression-free and overall survival. We found that the prognostic benefit of increased extent of resection for patients with medulloblastoma is attenuated after molecular subgroup affiliation is taken into account. We identified a progression-free survival benefit for gross total resection over sub-total resection (hazard ratio [HR] 1.45, 95% CI 1.07-1.96, p=0.16) but no overall survival benefit (HR 1.23, 0.87-1.72, p=0.24). We saw no progression-free survival or overall survival benefit for gross total resection compared with near-total resection (HR 1.05, 0.71-1.53, p=0.8158 for progression-free survival and HR 1.14, 0.75-1.72, p=0.55 for overall survival). No significant survival benefit existed for greater extent of resection for patients with WNT, SHH, or group 3 tumours (HR 1.03, 0.67-1.58, p=0.89 for sub-total resection vs gross total resection). For patients with group 4 tumours, gross total resection conferred a benefit to progression-free survival compared with sub-total resection (HR 1.97, 1.22-3.17, p= 0.0056), especially for those with metastatic disease (HR 2.22, 1.00-4.93, p= 0.050). However, gross total resection had no effect on overall survival compared with sub-total resection in patients with group 4 tumours (HR 1.67, 0.93-2.99, p= 0.084). Interpretation The prognostic benefit of increased extent of resection for patients with medulloblastoma is attenuated after molecular subgroup affiliation is taken into account. Although maximum safe surgical resection should remain the standard of care, surgical removal of small residual portions of medulloblastoma is not recommended when the likelihood of neurological morbidity is high because there is no definitive benefit to gross total resection compared with near-total resection.
Návaznosti
EE2.3.20.0183, projekt VaV |
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