多中心脑胶质瘤诊治的临床研究  

Treatment and pathological mechanism of multicentric glioma

作　　者：严勇[1] 王洪祥[1] 徐涛[1] 秦荣[1] 卢成寅 胡国汉[1] 卢亦成[1] 陈菊祥[1] 

机构地区：[1]第二军医大学附属长征医院神经外科,全军神经外科研究所,上海市神经外科研究所,上海200003

出　　处：《中华医学杂志》2015年第13期991-995,共5页National Medical Journal of China

基　　金：国家自然科学基金（81272781,81101908）

摘　　要：目的探讨多中心脑胶质瘤的诊治方案和潜在的发病机制。方法对象：（1）2012年1月至2014年12月，前瞻性的收集上海长征医院神经外科收治的多中心脑胶质瘤患者5例。（2）通过国内外文献检索收集到的临床资料较完备的多中心胶质瘤病例，对可能影响预后的相关因素进行单因素（K．M法）和多因素（COX回归法）生存分析。结果共收集到62例（包括前述5例）多中心胶质瘤的临床资料；年龄55±14（11—78）岁；男：女1．27；62例中同期多中心脑胶质瘤48例，非同期13例；总体中位生存时间8（0．5—84）个月，非同期多中心胶质瘤出现新发病灶为时间截点，中位生存时间7（0～21）个月；单因素生存分析发现，年龄、是否手术切除病灶（单个或多个）、放疗、化疗等因素对多中心胶质瘤预后的影响差异有统计学意义（P〈0．05）；多因素生存分析发现，仅手术切除病灶和术后进行辅助化疗对预后的影响差异有统计学意义（P〈0．05）。结论多中心脑胶质瘤以高级别的恶性胶质瘤多见，预后差，尽可能的手术切除病灶和术后规范放、化疗有助于改善患者预后，针对多个病灶的调强放疗有益于患者。Objective To explore the diagnosis and treatment of muhicentric glioma and discuss its underlying pathological mechanism. Methods The clinical cases of muhicentric glioma at our department were prospectively collected from January 2012 to December 2014. A total of 62 cases, along with the literally reported cases with relative complete data, were studied with Kaplan-Meier and COX regression to identify the prognostic factors of disease. Results The median age was 55.3 ± 14. 3 （ 11 -78 ） years. The ratio of male-to-female was I. 27. There were synchronous （ n = 48 ） and multichronous （ n = 13 ） multicentric gliomas. The median survival time was 8 months and 7 months if calculated from the appearance of new tumor. Kaplan-Meier analysis revealed that the survival time was correlated with age, resection of tumor, radiotherapy and chemotherapy. And COX regression analysis indicated that only resection of tumor （s） and chemotherapy were independently correlated with the prognosis of muhicentric glioma. Conclusion Multieentric glioma is mainly of high-grade glioma with a very poor prognosis. Total resection and standard chemotherapy yield a better prognosis. Radiotherapy should be prudent if there are signs of intracranial hypertension.

关 键 词：多中心胶质瘤 显微手术 放疗 化疗 预后 

分 类 号：R739.4[医药卫生—肿瘤]