影响多中心脑胶质瘤患者预后的因素分析  

Prognosis factor analysis of cranial multicentric gliomas

作　　者：薛湛[1] 李德岭[1] 李桂林[2] 王宇[1] Xue Zhan Li Deling Li Guilin Wang Yu(Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050 [2]首都医科大学,北京市神经外科研究所

出　　处：《中华神经外科杂志》2017年第3期234-238,共5页Chinese Journal of Neurosurgery

基　　金：国家科技支撑计划（2014BAI04B01）

摘　　要：目的探讨影响多中心脑胶质瘤患者预后的相关因素。方法回顾性纳入2013年2月至2016年2月首都医科大学附属北京天坛医院神经外科经手术治疗的成人多中心脑胶质瘤患者，共24例。术后16例行放疗＋化疗，2例行单独放疗，1例行单独化疗，5例无任何辅助治疗。用Kaplan—Meier分析法分析生存率，对可能影响预后的相关因素进行单因素和多因素（Cox回归）分析。结果24例患者共51个病灶，其中21例有2个病灶，3例有3个病灶；其中单个肿瘤体积为0．02—133．88（P2,：3．15，P，，：25．20）cm^3；高级别胶质瘤19例，低级别胶质瘤5例。24例中，11例的整体肿瘤减负率〉t85％，13例〈85％。随访6．0—33．6个月，整体生存分析显示，1年生存率为76．0％，2年为12．0％，中位生存时间为16．0个月。单因素分析显示，患者术前Karnofsky功能状态评分（KPS）、肿瘤整体减负率及是否行术后放疗＋化疗是影响术后生存时间的因素；多因素分析显示，术前KPS（RR=8．526，95％CI：1．637—44．404，P=0．011）和是否术后行放疗＋化疗（RR=0．160，95％CI：0．033～0．775，P=0．023）是影响患者生存期的独立因素。结论多中心脑胶质瘤以高级别胶质瘤为主，对主要病灶进行切除并给予规范放化疗可以改善患者的预后。Objective To explore the prognosis factors of cranial multicentric gliomas. Methods A total of 24 cases of cranial mnlticentric gliomas were retrospectively analyzed who were admitted to Department of Neurosurgery, Beijing Tiantan Hospital , Capital Medical University and underwent surgical operation from February 2013 to February 2016. Postoperatively, 16 cases received radiotherapy and chemotherapy, 2 cases received only radiotherapy, 1 case underwent only radiotherapy and no supplementary therapy was conducted in 5 cases. Kaplan-Meier survival analysis was performed and univariate and multivariate analysis were used to investigate the prognosis factors. Results There were totally 51 lesions in the 24 cases, among them 21 patients had 2 lesions and 3 patients had 3 lesions. The largest tumor measured 133.88 cm3 and the smallest was 0.02（ P25：3.15 ,P75：25.20） cm3. Among them, 19 cases were high-grade gliomas and 5 cases were low-grade gliomas. Overall survival analysis showed that the survival rate for 1 year was 76.0% , and that for 2 years was 12.0% , and the median survival time was 16.0 months. Univariate analysis revealed that the survival time was correlated with pre-operative Karnofsky performance status （KPS）, tumor resection rate and post-operative radiotherapy and chemotherapy. The multivariate analysis indicated that pre-operative KPS （ RR = 8. 526,95% CI： 1. 637 - 44. 404, P =0. 011 ） and post-operative radiotherapy and chemotherapy （ RR = 0. 160,95% CI：0. 033 - 0. 775, P = 0. 023 ） were independently correlated with the prognosis of mnltieentric gliomas. Conclusion Cranial multicentric gliomas seems mainly high-grade gliomas, resection of main lesions and standard radiotherapy and chemotherapy may yield a better prognosis.

关 键 词：神经胶质瘤 神经外科手术 化放疗 预后 

分 类 号：R739.41[医药卫生—肿瘤]