新发成人幕上胶质母细胞瘤切除程度和残余体积与预后的相关性研究  

Correlation of the extent of tumor volume resection and patient survival in surgery of new-onset adult supratentorial glioblastoma

作　　者：邢亚洲[1] 张佳栋[1] 孙勇[1] 梁庆华[1] 史锡文[1] 

机构地区：[1]河南省人民医院神经外科,郑州450003

出　　处：《中华神经外科杂志》2016年第12期1253-1257,共5页Chinese Journal of Neurosurgery

摘　　要：目的评估新发成人幕上胶质母细胞瘤患者的肿瘤切除程度（EOR）和肿瘤残余体积（RTV）与预后的相关性。方法回顾性分析2010年1月至2013年12月河南省人民医院神经外科收治的98例新发成人幕上胶质母细胞瘤患者的临床资料。所有患者均行手术切除肿瘤，部分患者术后行规范放、化疗。对患者手术前后的肿瘤体积进行量化分析，采用Cox比例风险回归模型探讨EOR和RTV与患者的疾病无进展生存期（PFS）及总生存期（OS）的关系。随访时间为5．9～27．5个月，平均13．3个月。结果所有病例均获随访。98例患者的OS为（13．3±4．9）个月，PFS为（9．5±4．2）个月，研究结束时5例（5％）仍存活。EOR为0．91±0．12，RTV为（2．82±3．61）cm。。控制年龄、Kamofsky功能状态评分（KPS）以及术后辅助治疗措施后，统计学分析结果显示，成人幕上胶质母细胞瘤患者的EOR和RTV与PFS（P=0．000，P=0．000）以及OS（P=0．000，P=0．000）均有明显相关性。肿瘤RTV≤5．5cm。，EOR〉0．85时患者的生存时间明显改善。将EOR、RTV同时与年龄、KPS评分和术后辅助治疗纳为自变量进行分析，结果表明，RTV可能为影响预后的独立因素（RTV与0s：P=0．000，RTV与PFS：P=0．000），而EOR可能并非影响预后的独立因素（EOR与OS：P=0．880，EOR与PFS：P=0．665）。结论RTV对新发成人幕上胶质母细胞瘤患者的预后有预测价值。Objective To investigate the correlation of extent of resection （EOR） as well as residual tumor volume （RTV） and prognosis of new-onset adult supratentorial glioblastoma （ GBM ）. Methods A retrospective review of 98 adult patients was conducted who were diagnosed with supratentorial GBM and admitted to Department of Neurosurgery, Henan Provincical People＇S Hospital from January 2010 to December 2013. All patients in this group underwent primary resection of tumors, while some followed by standardized radiotherapy and chemotherapy. Quantitative analysis of pre- and postoperative tumor volumes were conducted, and the Cox proportional hazards regression model was utilized to study the correlation of EOR as well as RTV and the patients＇progression-free survival （PFS） and overall survival （OS）. The mean period of follow-up was 13.3 （5.9 - 27.5） months. Results All patients were successfully followed up. Among them, 5 （5%） patients were alive at the final follow-up. The OS and PFS were 13.3 ±4.9 months and 9.5 ±4.2 months, respectively. The RTV was 2.82± 3.61 cm3, equating to an EOR of 0.91 ± 0.12. Both RTV （ P = 0. 000） and EOR （ P = 0. 000） were statistically significant predictors of survival when controlling for age, Karnofsky performance score （KPS） and adjuvant postoperative therapies. A statistically significant benefit in survival was seen with a RTV no more than 5.5 cm3 or an EOR greater than 0. 85. But the relevance of EOR and survival was inexistent when EOR （P = 0.880, P = 0. 665 ） and RTV（ P = 0. 000, P = 0. 000）were simultaneously taken in, which suggested that RTV rather than EOR was an independent predictor of survival. Conclusion RTV was found to be a significant predictor of survival for patients with new-onset adult supratentorial GBM.

关 键 词：胶质母细胞瘤 神经外科手术 预后 切除程度 肿瘤残余体积 

分 类 号：R739.4[医药卫生—肿瘤]