手术切除程度对高级别胶质瘤病人预后的影响:单中心303例病例研究  

Influence of surgical resection extent on the prognosis of patients with high-grade gliomas:a single center study with 303 cases

作　　者：李凌[1] 邹叔骋[1] 罗宗晚[1] 李创华[1] 刘博[1] 刘坤[1] 张卫民[1] 刘华[1] 黄红星[1] 

机构地区：[1]湖南省脑科医院神经外科,长沙410007

出　　处：《中国微侵袭神经外科杂志》2017年第12期544-547,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：湖南省卫计委科研课题计划项目(2015-45);湖南省临床重点专科建设项目(2015)

摘　　要：目的探讨手术切除程度对高级别胶质瘤病人预后的影响。方法回顾性分析303例高级别胶质瘤病人的临床资料,包括间变型胶质瘤(WHOⅢ级)126例,胶质母细胞瘤(WHOⅣ级)177例。均进行异柠檬酸脱氢酶(IDH)基因检测,并统计分析各项临床资料数据与总生存期(OS)的关系。结果单变量分析显示:年龄<55岁,全部完成放化疗方案,IDH-1R132H基因突变型,术前KPS评分≥70分,WHOⅢ级肿瘤及手术全切除病人的中位OS更长(P<0.05)。Kaplan-Meier生存曲线显示:肿瘤切除程度越高,病人预后越好(P<0.05)。多变量分析显示:年龄、病理级别、手术切除程度、放化疗和IDH-1132H基因类型均是预测病人预后的独立风险指标。结论高级别胶质瘤预后差,需要手术结合术后放化疗综合治疗;肿瘤全切除对延长病人OS、提高生活质量具有重要意义。Objective To investigat e the i nfluence of s urgical resection extent on the prognosis of patients with high-grade gliomas.Methods Clinical data of 303 patients with high-grade gliomas were analyzed retrospectively,including 126 anaplastic gliomas（WHO grade Ⅲ） and 177 glioblastomas（WHO grade Ⅳ）.Isocitrate dehydrogenase（IDH） gene was detected,and the relationship between clinical data and overall survival（OS） was analyzed statistically.Results The univariate analysis indicated that the better OS was associated with age less than 55 years,complete radio-and chemotherapy,IDH-1 R132 Hmutations,preoperative KPS more than 70 points and total tumor resection（P 0.05）.Kaplan-meier survival curve showed that the higher the tumor resection extent,the better the patient＇s prognosis（P 0.05）.In the multivariate analysis,age,tumor grade,surgical resection extent,complete radio-and chemotherapy and IDH-1 R132 Hgene type were all independent prognostic factors（P 0.05）.Conclusions High-grade gliomas with poor prognosis require a combination treatment of surgery,radiotherapy and chemotherapy.Besides,total tumor resection is of great significance in improving OS and life quality for patients with high-grade gliomas.

关 键 词：神经胶质瘤 肿瘤切除程度 异柠檬酸脱氢酶 总生存期 

分 类 号：R739.41[医药卫生—肿瘤]