高分级脑胶质瘤术后精确放疗患者的预后影响因素  

Prognostic factors of high grade gliomas after radiotherapy

作　　者：陈琴[1] 向琰[1] 

机构地区：[1]第三军医大学附属新桥医院神经外科,重庆400037

出　　处：《现代肿瘤医学》2016年第2期212-215,共4页Journal of Modern Oncology

基　　金：国家自然科学基金(编号:81071043)

摘　　要：目的：分析高分级脑胶质瘤术后精确放疗患者预后的危险因素及干预对策。方法：回顾自2009年6月至2013年6月入我院的病理诊断为高分级脑胶质瘤术后精确放疗的患者资料。对患者的一般情况如性别、年龄、手术切除程度、病理分级、化疗、放疗量、KPS评分、术前癫痫发作、总生存期（随访2年）等数据进行分析,评价高分级脑胶质瘤术后精确放疗患者预后的危险因素。结果：在123例患者中,年龄16~86岁,平均发病年龄46.9岁,男性平均发病年龄42.0岁,女性平均发病年龄49.5岁。小于40岁患者68例,大于等于40岁患者55例。从发病到明确诊断平均时间9.8月,中位生存时间19个月,1年生存率69%,2年生存率37.4%。单因素分析显示,年龄、手术切除程度、病理分级、化疗与高分级脑胶质瘤术后精确放疗患者预后显著相关（P〈0.05）,性别、放疗、术前癫痫发作、KPS评分与高分级脑胶质瘤术后精确放疗患者预后无明显相关（P〉0.05）。多因素COX回归分析显示,年龄〈40岁（RR=1.844,95%CI：1.047~3.249）、肿瘤全切（RR=2.348,95%CI：1.389~3.968）、病理分级3级（RR=2.632,95%CI：1.479~4.684）、同步替莫唑胺化疗（RR=0.557,95%CI：0.329~0.944）能够显著延长患者的总生存时间。结论：年龄、手术切除程度、病理分级、化疗等是高分级脑胶质瘤术后精确放疗患者生存预后的危险因素。年龄〈40岁、肿瘤全切、病理分级低、同步化疗患者生存预后较好。Objective： To analyze the high- grade glioma risk factors of postoperative radiotherapy accurate prognosis and intervention measures. Methods： Data of 123 patients was retrospectively analyzed for high- grade glioma risk factors of postoperative radiotherapy accurate prognosis. Results： We observed 123 patients in the age 16 ~ 86 years old,mean age 46. 9 years old. The median survival time was 19 months,1- year survival rate was 69%,2- year survival rate was 37. 4%. By univariate analysis,age,extent of surgical resection,tumor grade,chemotherapy and high grade gliomas after radiotherapy accurate prognosis significantly correlated（ P〈0. 05）. Gender,radiotherapy,preoperative seizures,KPS score with high grade brain postoperative radiotherapy accurate prognosis was no significant correlation（ P〈0. 05）. Multivariate COX regression analysis showed,age 40 years old（ RR = 1. 844,95% CI： 1. 047 ~3. 249）,total resection（ RR = 2. 348,95% CI： 1. 389 ~ 3. 968）,histological grade 3 level（ RR = 2. 6 3 2,9 5 %CI ： 1. 479 ~ 4. 684）,synchronous temozolomide chemotherapy（ RR = 0. 557,95% CI： 0. 329 ~ 0. 944） can significantly prolong overall survival time of patients. Conclusion： Age,extent of surgical resection,histological grade,chemotherapy and other high- grade gliomas after radiotherapy accurate survival are prognostic factors,age 40 years old,total resection,low histological grade,concurrent chemotherapy survival prognosis is good.

关 键 词：高分级脑胶质瘤 精确放疗 生存预后 危险因素 

分 类 号：R730.55[医药卫生—肿瘤] R730.264[医药卫生—临床医学]