复发性高级别胶质瘤患者再手术的风险及预后评估  

Assessment of the prognosis and risks of reoperation on patients with recurrent high-grade glioma

作　　者：徐维林[1] 王强[1] 张宏伟[1] 朱巍[1] 马晓东[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华保健医学杂志》2016年第2期123-127,共5页Chinese Journal of Health Care and Medicine

基　　金：首都临床特色应用研究与成果推广项目(031717)

摘　　要：目的分析影响复发性高级别胶质瘤患者的预后因素,并探讨再次手术,特别是老年复发性高级别胶质瘤患者(≥60岁)再次行手术治疗的指征及疗效。方法随访记录143例复发性高级别胶质瘤患者两次手术时间间隔、再次术后生存时间(OS)、并发症发生率、术前及术后KPS评分、Ki-67,以及肿瘤切除率是否进行放化疗等指标,统计比较相关指标后分析影响患者的预后因素,并进一步探讨患者接受再次手术的指征及疗效。结果老年患者(≥60岁)再次手术后OS明显较非老年患者缩短(8个月vs 16个月,P<0.01);首次手术后病理级别与再次手术后OS成负相关(P<0.05),但是再次手术后病理对于患者OS的影响差异未见明显统计学意义(P>0.05);两次手术时间间隔对患者再次手术后OS有影响,并且手术时间间隔>20个月的患者预后较<20个月的患者好(14个月vs 9个月,P<0.01);再次手术术前KPS≥70的患者再次术后OS较KPS<70的患者延长(16个月vs 12个月,P<0.01),但再次术后KPS对于OS的影响差异未见明显统计学意义;Ki-67与患者的病理级别成正相关(P<0.01),并且Ki-67的变化与患者病理级别成正相关;再次手术后行替莫唑胺(TMZ)放化疗能延长患者再次手术OS(P<0.01)。结论年龄(老年及非老年组)、两次手术时间间隔(时间间隔是否>20个月)、首次手术后病理(低级别和高级别)、再次术前KPS(是否>70)、术后放化疗是复发性高级别胶质瘤患者的独立预后因素。对于复发高级别胶质瘤患者,再次手术及术后行TMZ同步放化疗能够明显延长患者的OS,但是对于老年患者,特别是对于短时间内复发、术前KPS评分<70的患者,再次手术需要慎重。Objective To analyze prognostic factors of recurrent high-grade gliomas,and explore the indication and curative effect of reoperation on the patients,especially in elderly patients（≥ 60 years old） with recurrent high-grade gliomas. Methods One hundred and forty-three high-grade gliomapatients were included. The time between twice operations,the rate of complication,KPS score,Ki-67,the resection rate of tumor,MRI and progression free survival or overall survival were statistically analyzed among them. Results survival time of elderly patients（aged ≥ 60） after reoperation（OS） significantly shorter than non-elderly patients（8 vs 16 months; P〈0.01）;Pathological grade of the first surgery has negative correlation for the OS after reoperation（P〈0.05）,but the pathological grade of second surgery has no obvious statistical significance on the OS（P〉0.05）; Interval between the two operations has influence on the OS after reoperation,and the patients with interval greater than 20 months has better prognosis than patients with intervalless than 20 months（14 months vs 9 months; P〈0.01）; The patients with KPS ≥ 70 has longer OS than the patients with KPS 70 patients before reoperation（16 vs 12; P〈0.01）,but KPS after reoperation had no obvious effect on OS;Pathological grade of patients has positive correlation with Ki-67（P〈0.01）,the changes of pathological grade increased consistent with the increase of Ki-67（P〈0.01）; Chemoradiotherapy after reoperation can prolong the OS of the patients（P〈0.01）.Conclusion Age（elderly and non elderly group）,time interval of twice operations（interval is greater than 20 months or not）,the pathology after first surgery（low grade and high grade）,KPS before reoperation（greater than 70 or not）,postoperative chemoradiotherapy are independent prognostic factors for recurrent high-grade glioma patients. For patients with recurrent high-grade gliomas,reoperation and postoperative TMZ concurrent chemoradiotherapy can signif

关 键 词：复发性肿瘤 胶质瘤 老年性 再次手术 

分 类 号：R739.4[医药卫生—肿瘤]