高级别脑胶质瘤术后放疗联合替莫唑胺或司莫司汀化疗的效果比较  

Efficacy of temozolomide and semustine chemotherapy in combination with radiotherapy in patients after high-grade glioma operation

作　　者：彭钢[1] 年福甲 刘圣杰[1] 马骏[1] 乔冠群[1] 李凯[1] 宋军[1] 肖安平[1] 李英斌[1] 

机构地区：[1]南京医科大学第二附属医院神经外科,210011

出　　处：《中国医药》2017年第3期361-364,共4页China Medicine

基　　金：南京市科技发展计划（201402011）

摘　　要：目的比较高级别脑胶质瘤术后放疗联合替莫唑胺或司莫司汀化疗的效果及安全性，同时初步评估基因多态性对术后化疗的影响作用。方法回顾性分析2010年1月至2013年12月在南京医科大学第二附属医院住院治疗并经病理学证实为Ⅲ～Ⅳ级的85例脑胶质瘤患者的临床资料，根据术后放疗联合化疗药物的不同分为替莫唑胺组（45例）与司莫司汀组（40例）。观察其临床疗效，包括生存时间、年生存率、肿瘤复发时间、患者生活质量改善情况以及化疗药物安全性，并分析2组患者肿瘤基因检测结果的差异性。结果替莫唑胺组平均生存时间长于司莫司汀组[（1．83±0．21）年比（1．01±0．07）年]，差异有统计学意义（P=0．037）。替莫唑胺组1年生存率高于司莫司汀组[57．8％（26／45）比25．0％（10／40）]，差异有统计学意义（P=0．002），2组2年生存率差异无统计学意义（P=0．160）。替莫唑胺组肿瘤平均复发时间长于司莫司汀组[（1．51±0．23）年比（0．87±0．07）年]，差异有统计学意义（P=0．046）。2组患者术后生活质量改善情况差异无统计学意义（P=0．225）。2组患者化疗期间白细胞计数降低、肝肾功能损害、消化道症状发生率比较，差异均无统计学意义（均P〉0．05）。2组患者肿瘤06_甲基鸟嘌呤DNA甲基转移酶甲基化和1p／19q杂合性缺失检测结果差异均无统计学意义（均P〉0．05）；2组切除修复交叉互补基因1检测结果差异有统计学意义（P〈0．01）。结论高级别脑胶质瘤患者术后放疗联合替莫唑胺疗效优于司莫司汀，其原因可能与患者肿瘤基因多态性有关。Objective To evaluate clinical efficacy and safety of postoperative radiotherapy combined with temozolomide（TMZ） or semustine（MeCCNU） chemotherapy in treating high-grade intracranial glioma and to analyze effect of gene polymorphism on postoperative chemotherapy. Methods Clinical data of 85 patients with high-grade glioma who had surgical treatment and confirmed of Ⅲ-Ⅳ grade by pathology in the second affiliated hospital of Nanjing Medical University form January 2010 to December 2013 were collected. The patients were divided into TMZ group （n = 45 ） and CCNU group （n = 40） according to the use of postoperative chemotherapy drugs. Survival time, survival rate, relapse time, quality of life and safety of chemotherapy were observed. Results of tumor gene detection were analyzed. Results The average survival time in TMZ group was significantly longer than that in MeCCNU group[ （ 1.83 ± 0.21 ） years vs （ 1.01 ± 0.07 ） years ] （ P = 0. 037 ）. The 1 year survival rate in TMZ group was significantly higher than that in MeCCNU group[57.8% （26/45） vs 25.0% （10/40）] （P = 0. 002）. The 2-year survival rate had no significant difference between groups（P = 0. 160）. The average tumor relapse time in TMZ group was significantly longer than that in MeCCNU group [ （ 1.51 ± 0.23 ） years vs （0.87 ± 0.07） years I （P = 0.046）. The improvement of life quality after chemotherapy had no significant difference between groups（P =0.225）. Incidences of white blood cell decreasing, liver and kidney impairment, and gastrointestinal symptoms had no significant differences between groups （ P 〉 0.05 ）. Detection results of O6-methylguanine-DNA methyltransferase methylation and Ip/19q heterozygosity deletion had no significant differences between groups（P 〉 0.05） ; the detection result of excision repair cross-complementing gene 1 had a significant difference between groups（P 〈0.01 ）. Conclusion TMZ is more effective than MeCCNU in combination with radiotherapy i

关 键 词：神经胶质瘤 替莫唑胺 司莫司汀 

分 类 号：R739.41[医药卫生—肿瘤]