31例颅内室管膜瘤术后放射治疗的预后分析  

Prognostic factors for 31 cases of intracranial ependymomas after postoperative radiotherapy

作　　者：宋丽楠[1] 房彤[1] 孙保锦[1] 侯栋梁[1] 陈力[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院放疗科,北京100038

出　　处：《中华放射医学与防护杂志》2016年第3期202-206,共5页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的讨论颅内室管膜瘤的临床特点、治疗转归和预后因素。方法回顾性分析2009年1月-2012年6月收治的31例颅内室管膜瘤术后放射治疗患者的临床资料，男22例，女9例，平均年龄18岁（3—60岁）；17例患者行手术全切，14例患者行次全切除；平均放疗剂量53．9Gy（48．6～60Gy）；观察疗效，分析患者3和5年的疾病无进展时间，总生存时间。对年龄、性别、肿瘤部位、手术切除情况、病理分级、放疗方式、放疗剂量、辅助治疗8个因素进行单因素分析，Cox比例风险模型分析影响预后的因素。结果中位随访51个月。7例患者术后放疗后复发，5例为原位复发，2例发生全中枢播散。死亡患者6例，其中4例为儿童第Ⅳ脑室间变性室管膜瘤患者。3和5年的无进展生存率（PFS）分别为80．6％和75．9％，3和5年的总生存率（OS）分别为83．9％和76．2％。手术全切组（17／31）和次全切除组（14／31）的3年和5年PFS分别为94．1％和64．3％，90．9％和57．1％，差异均有统计学意义（χ2=4．685、6．311，P〈0．05）；手术全切组和次全切除组的5年0s分别为83．3％和64．3％，差异有统计学意义（χ2=4．238，P〈0．05）。放疗剂量≤55Gy和〉55Gy两组患者的5年PFS分别为64．2％和100．0％，差异有统计学意义（χ2=4．210，P〈0．05）。未观察到严重的不良反应。结论手术是室管膜瘤的首选治疗方法，部分切除和间变性室管膜瘤患者，术后放疗是最重要的辅助手段。手术切除程度和放疗剂量影响室管膜瘤患者预后。Objective To evaluate the prognostic factors and treatment results of intracranial ependymomas （EPs）. Methods Thirty-one intraeranial EPs patients who received postoperative radiotherapy in Beijing Shijitan Hospital between January 2009 and June 2012 were analyzed retrospectively. Twenty-two males and 9 females had an average age of 18 years （ range 3-60 years）. Seventeen patients received gross total resection （GTR） while fourteen received subtotal resection （STR）. Median total radiation dose was 53, 9 Gy （48.6 - 60 Gy）. The three-year and five-year progress-free survival （PFS） and overall survival （OS） were estimated with the Kaplan-Meier method. Univariate analysis was performed using eight clinical and dosimetric factors by Log-Rank testing. Cox proportional hazards model was used to identify the independent prognostic factors correlated to EPs. Results The median time of follow-up was 51 months. At the endpoint of the follow-up period, 7 patients experienced tumor recurrence： 5 had a local recurrence （LR） and 2 had both LR and distant recurrence. Six patients died, 4 of which had cases of pediatric infratentorial anaplastic EPs. The three and five-year progress-free survival （PFS） were 80.6% and 75.9%. Overall survival （OS） at three-year and five-year were 83.9% and 76.2% , respectively. Univariate analysis showed a more favorable prognoses in terms of three-year PFS, five-year PFS and OS for GTR compared to STR （ χ2 =4, 685,6. 311,4. 238, P 〈0.05）. Besides, a more favourable univariate outcome in terms of five-year PFS was evident in patients when the total radiotherapy dose was 〉55 Gy compared to ≤55 Gy （χ2 =4. 210, P 〈0.05）, and no severe radiotherapycomplications occurred. Conclusions Surgery is the major treatment method, while adjuvant radiotherapy is important for subtotal resection and anaplastic EPs patients. Surgical resection and radiotherapy dose were relevant to prognosis.

关 键 词：室管膜瘤 手术 放射治疗 预后因素 

分 类 号：R739.41[医药卫生—肿瘤]