髓母细胞瘤手术联合放疗及放化疗病例的回顾性分析  

A retrospective analysis of surgery combined with radiotherapy or surgery combined with radiotherapy plus chemotherapy for medulloblastoma patients

作　　者：朱琳[1] 章婧文 王慧[1] 吴德华[1] 

机构地区：[1]南方医科大学南方医院放疗科,广州510515

出　　处：《中华神经医学杂志》2015年第3期239-243,共5页Chinese Journal of Neuromedicine

摘　　要：目的 比较手术联合放疗与放化疗对髓母细胞瘤患者生存率的影响,分析影响其预后的相关因素. 方法 回顾性分析南方医科大学南方医院自2002年6月至2014年1月收治的79例髓母细胞瘤患者的临床资料,比较术后放化疗与术后单纯放疗对髓母细胞瘤患者5年生存率、无瘤生存率的影响,Cox回归模型分析影响髓母细胞瘤患者预后的相关因素. 结果 本组患者中74例行肿瘤全切术,5例行次全切术;术后单纯放疗41例,术后放化疗38例.术后单独放疗与术后放化疗患者的5年生存率（73.2％vs 81.6％）、无瘤生存率（65.9％vs 76.3％）比较差异均无统计学意义（P＜0.05）.有术后肿瘤残留和复发转移、是高风险人群的患者5年生存率分别低于无术后残留、非高风险人群患者,差异均有统计学意义（P＜0.05）; Cox回归模型表明,高风险人群相对危险度[（RR）=22.461,P=0.038]、复发转移（RR=65.547,P=0.000）是影响髓母细胞瘤预后的独立危险因素. 结论 髓母细胞瘤的治疗首选手术切除＋术后放射治疗.属于高风险人群、有复发转移的髓母细胞瘤患者预后较差.Objective To compare the survival benefit of surgery combined with radiotherapy or surgery combined with radiotherapy plus chemotherapy for medulloblastoma patients,to analyze the related prognostic factors.Methods The clinical data of 79 patients with medulloblastoma,admitted to our hospital from June 2002 to January 2014,were retrospectively analyzed; the 5-year overall survival and event-free survival of patients accepted surgery combined with radiotherapy or surgery combined with radiotherapy plus chemotherapy were compared; Cox regression model was used to analyze the related prognostic factors.Results Totally,74 patients accepted total removal and 5 subtotal removal;after the surgery,radiotherapy only was performed in 41 patients and radiotherapy plus chemotherapy in 38.The overall survival （73.2% vs.81.6%） and event-free survival （65.9% vs.76.3%） showed no significant differences between patients receiving radiotherapy and patients receiving radiotherapy plus chemotherapy after surgery （P〉0.05）.The 5-year overall survival in patients with residual tumor or recurrence and patients classified as high risk population was significantly lower than that in patients without residual tumor or recurrence and patients not classified as high risk population （P〈0.05）; The Cox regression analysis showed that the high risk population （RR=22.461,P=0.038） and recurrence/metastasis （RR=65.547,P=0.000） are independent risk factors influencing the prognosis of medulloblastoma.Conclusions Surgical resection plus postsurgical radiotherapy acts as the first choice for treatment of medulloblastoma.Patients classified as high risk population and patients with recurrence/metastasis have poor prognosis.

关 键 词：髓母细胞瘤 放射治疗 化学疗法 回顾性分析 预后 

分 类 号：R739.4[医药卫生—肿瘤]