DOES TIME TO DIAGNOSIS INFLUENCE SURGICAL DECISION MAKING IN PRIMARY MALIGNANT BRAIN TUMOURS?
Journal of Neurology, Neurosurgery, and Psychiatry(2019)
摘要
Objectives To assess whether time to diagnosis influenced surgical procedure and survival in primary malignant brain tumours Design Retrospective cohort study of adult patients newly diagnosed with a primary intra-cerebral tumour April 2010 – March 2015 referred to neuro-oncology centre in South-East Scotland Subjects 400 patients with primary malignant intracerebral tumours Methods Univariate logistic regression analysis and multivariate Cox regression survival analysis were performed Results Our dataset included 229 Males (57.7%), mean age 62.05 (SD14.01). Time to diagnosis did affect choice of surgical procedure. Patients undergoing biopsy had significantly longer TtD than those undergoing resection (28 vs 21 days, MWU test, p=0.035). 233 (58.3%) patients were deceased at 12 months. Having a cognitive first symptom (e.g confusion/memory changes) predicted not getting any surgical procedure (OR 2.95 [95% CI 1.8–4.8]). Where surgery was performed, first cognitive symptom was not predictive of type of surgery (biopsy vs debulking/excision) (OR 1.5 [95% CI 0.8–2.9] norhaving tumour in the frontal lobe (OR 0.9 [95% CI 0.5–1.7]. In multivariate analysis, increased hazard ratio of death at 12 month was significantly associated with a cognitive first symptom (HR 1.4 [95% CI 1.0–1.9] and KPS Conclusions Earlier diagnosis is associated with getting debulking surgery rather than biopsy, and patient’s presenting symptoms influence surgical decision making and outcome.
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