92例高级别胶质瘤患者术后生存分析  

Postoperative survival of high-grade glioma: An analysis of 92 cases

作　　者：刘志强 方薪淇 宋涛[1] 王莹[1] 黄天翔 马玉杰 伍军[1] Liu Zhi-qiang;Fang Xin-qi;Song Tao;Wang Ying;Huang Tian-xiang;Ma Yu-jie;Wu Jun(Department of Neurosurgery , Xiangya Hospital,Central South University,Changsha,Hunan,410008;Grade 2015 Major in Clinical Medicine,Xiangya Medical College,Central South University,Changsha ,Hunan ,410013)

机构地区：[1]中南大学湘雅医院神经外科,湖南长沙410008 [2]中南大学湘雅医学院,湖南长沙410013

出　　处：《国际神经病学神经外科学杂志》2018年第6期577-581,共5页Journal of International Neurology and Neurosurgery

摘　　要：目的探讨影响高级别胶质瘤术后生存的因素。方法对2014年1月至2016年8月首诊确定为高级别胶质瘤(WHO III-IV级)的92例患者采用Kaplan-Meier法分析生存率,Log-rank检验进行单因素分析,Cox回归模型进行多因素分析。结果中位生存期为15个月,中位无进展生存期为8个月,肿瘤全切率为72. 83%,1年、2年、3年、4年的生存率分别为56. 5%,35. 9%,30. 4%,25. 4%。Log-rank单因素分析表明高级别胶质瘤预后与年龄、术前生活质量评分、肿瘤大小、数目、是否累及多个皮层脑叶或者运动功能区、切除程度、病理级别、异柠檬酸脱氢酶基因是否突变、O-6-甲基鸟嘌呤DNA甲基转移酶基因启动子是否甲基化、Ki 67指数、术后是否进行放疗和/或化疗以及所进行的放化疗的方式、复发后是否积极治疗相关(P <0. 05)。引入检验水准(α=0. 01),COX多因素分析表明年龄、肿瘤切除程度、术后是否进行放疗和/或化疗是影响高级别胶质瘤预后的独立危险因素(P <0. 01)。结论发病年龄<65岁、肿瘤全切除、术后进行同步放化疗和辅助化疗的高级别胶质瘤患者预后较好。Objective To investigate the influencing factors for the postoperative survival of high-grade glioma. Methods A total of92 patients who were diagnosed with high-grade glioma( WHO grade III-IV) at initial diagnosis from January 2014 to August 2016 were enrolled. The Kaplan-Meier method was used to evaluate survival rate,the log-rank test was used for univiriate analysis,and the Cox regression model was used for multivariate analysis. Results The median survival time was 15 months,and the median progress-free survival was 8 months. The overall tumor resection rate was 72. 83%,and the 1-,2-,3-,and 4-year survival rates were 56. 5%,35. 9%,30. 4%,and 25. 4%,respectively. The log-rank univariate analysis showed that the prognosis of high-grade glioma was associated with age,preoperative Karnofsky Performance Scale score,size/number/location of tumors,whether multiple cerebral lobes or motor function regions were involved,extent of resection,pathological grade,presence or absence of isocitric dehydrogenase gene mutation,presence or absence of methylation of O-6-methylguanine-DNA methyltransferase gene promoter,Ki 67 index,whether radiotherapy and/or chemotherapy were performed after surgery and the mode of radiochemotherapy,and whether active treatment was given after recurrence( P < 0. 05). With a significance level of α = 0. 01,the Cox multivariate analysis showed that age,extent of resection,and whether radiotherapy and/or chemotherapy were performed after surgery were independent risk factors for the prognosis of high-grade glioma( P < 0. 01). Conclusions Patients with high-grade glioma with an age of onset of < 65 years,total tumor resection,and concurrent chemoradiotherapy and adjuvant chemotherapy after surgery tend to have good prognosis.

关 键 词：高级别胶质瘤 预后因素 治疗 生存分析 

分 类 号：R739.41[医药卫生—肿瘤]