手术切除程度对胶质母细胞瘤预后预测因素的影响  

Influence of extent of surgical resection on factors for predicting the prognosis of glioblastomas

作　　者：王永志[1,2] 杨帆[2] 季玉陈[3] 刘彦伟[2] 游赣[1,2] 张伟[1,2] 江涛 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050 [2]北京市神经外科研究所 [3]清华大学医学中心,北京100084

出　　处：《中国微侵袭神经外科杂志》2015年第7期289-292,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金(编号:81402052);卫生公益性行业科研专项(编号:201402008);国家高技术研究发展计划(863计划)(编号:2012AA02A508)

摘　　要：目的探讨肿瘤切除程度对胶质母细胞瘤生存预后预测因素的影响。方法回顾性分析135例接受肿瘤最大程度切除及术后辅助性放化疗的胶质母细胞瘤病人的临床资料,分析肿瘤切除程度对经典预后因素临床预测价值的影响。结果肿瘤全切除57例,近全切除78例。全切除和近全切除两组生存期存在显著性差异(20.8个月:13.8个月,P=0.003),单因素分析显示预后相关因素还有年龄(P=0.001)、术前KPS评分(P=0.001)、异柠檬酸脱氢酶1(IDH1)状态(P=0.005)和O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)启动子状态(P=0.017)。进一步亚组分析发现,在肿瘤全切除背景下MGMT的预后相关性没有统计学意义(P=0.464),年龄的预后价值也下降(P=0.046);COX多因素回归分析显示总生存期的独立预测因素仅有KPS(相对危险度:0.365,P=0.011)和IDH1(相对危险度:0.436,P=0.044)。结论肿瘤切除程度影响预后预测因素的临床价值,在评估预后相关因素时应充分考虑到手术切除质量的影响。Objective To investigate the influence of extent of surgical resection on the factors predicting prognosis in patients with glioblastoma. Methods Clinical data of 135 patients who received maximal extent of tumor resection and adjuvant chemoradiotherapy were analyzed retrospectively. The influences of surgical extent on clinical prognostic value of classical prognostic factors were analyzed.Results Based on the imaging evaluation after surgery, total tumor resection was achieved in 57 patients and subtotal resection in 78.The survival time was 20.8 and 13.8 months in total tumor resection and subtotal resection groups respectively and there was a significant difference between the two groups（P = 0.003）. Besides, a univariate analysis revealed that age（P = 0.001）, preoperative KPS score（P = 0.001）, isocitrate dehydrogenase 1（IDH1） status（P = 0.005） and MGMT promoter status（P = 0.017） were correlated with the prognosis. However, further subgroup analysis found the prognostic relevance of MGMT did not showed statistical significance（P =0.464） and the prognostic value of age was also weakened（P = 0.046） under total tumor resection. The COX analysis identified the only independent prognostic factors for overall survival time were KPS score（relative risk 0.365, P = 0.011） and IDH1 status（relative risk0.436, P = 0.044）. Conclusion The extent of tumor resection influences the prognostic values of the predictors for prognosis in glioblastoma, which should be taken into full account when assessing the factors associated with prognosis.

关 键 词：神经胶质瘤 胶质母细胞瘤 切除程度 预后 预测 

分 类 号：R739.41[医药卫生—肿瘤] R651.1[医药卫生—临床医学]