老年胶质瘤预后相关因素分析  

Analysis of prognostic factors for survival in elderly patients with glioma

作　　者：刘竞辉[1] 娄淼[1] 冀培刚[1] 李晨[1] 冯富强 李宝福[1] 徐梦 高国栋[1] 屈延[1] 王樑[1] LIU Jinghui;LOU Miao;JI Peigang;LI Chen;FENG Fuqiang;LI Baofu;XU Meng;GAO Guodong;QU Yan;WANG Liang(Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi＇an 710038;Department of Neurosurgery, Second Hospital of Shanxi Medical University, Taiyuan 030001, China)

机构地区：[1]第四军医大学唐都医院神经外科,西安710038 [2]山西医科大学第二医院神经外科,太原030001

出　　处：《中南大学学报（医学版）》2018年第4期403-409,共7页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81402081,81772661)

摘　　要：目的:探讨影响老年胶质瘤患者预后的相关因素。方法:回顾性分析2014年6月至2017年6月年龄大于60岁的老年胶质瘤患者的临床资料和分子病理学资料。分析性别、年龄、肿瘤大小、病理级别、手术切除程度、辅助治疗、手术前后卡氏量表(Karnofsky Performance Scale,KPS)评分及分子标志物异柠檬酸脱氢酶-1(isocitrate dehydrogenase-1,IDH-1)、O6-甲基鸟嘌呤DNA甲基转移酶(O6-methylguanine DNA-transferase,MGMT)、表皮生长因子受体(epidermal growth factor receptor,EGFR)、Ki-67的表达等与预后的相关性。结果:共有45例患者纳入研究,中位总生存时间(overall survival,OS)11.0个月,中位无进展生存时间(progression-free survival,PFS)6.0个月。单因素分析显示:性别、年龄、肿瘤大小、病理级别、术前KPS评分与OS和PFS无显著相关,手术全切、较高的术后KPS评分、术后接受辅助治疗、较低的Ki-67指数、MGMT未表达、EGFR未表达是预后较好的相关因素。多因素分析发现较高的术后KPS评分(P=0.019)、术后接受辅助治疗(P=0.024)以及MGMT未表达(P=0.026)均与患者中位OS和PFS较好的预后有显著相关。结论:老年胶质瘤预后相关因素有辅助治疗、术后KPS评分、分子标志物的表达等,但仍需多中心临床研究验证。Objective： To analyze the prognostic factors for survival in elderly patients with glioma. Methods： We performed a retrospective analysis of prognostic factors for elderly patients with glioma, who were treated by the same attending doctor during June 2014 and June 2016, to investigate the correlations of the age, dimension of pathology, histological grade, extent of resection, adjuvant therapy, preoperative Karnofsky Performance Scale（KPS） score, postoperative KPS score, molecular markers [isocitrate dehydrogenase-1（IDH-1）, O6-methylguanine DNAtransferase（MGMT）, epidermal growth factor receptor（EGFR）, Ki-67] with the prognosis. Results： A total of 45 patients were included in the study. The median overall survival（OS） was 11 months. The median progression-free survival（PFS） was 6 months. Univariate analysis revealed that the age, gender, dimension of pathology, histological grade and preoperative KPS score had no significant correlation with survival（P〉0.05）. The gross total resection, higher postoperative KPS score, adjuvant therapy, lower Ki-67 index were significantly correlated with survival. The expressions of MGMT and EGFR were significant factors for survival. High postoperative KPS score（P=0.019）, adjuvant therapy（P=0.024）, and the expression of MGMT（P=0.026） were independent predictors for increased median OS in a multivariate regression model. Conclusion： The extent of resection, adjuvant therapy, postoperative KPS score and molecular markers are the influential factors for survival. Larger prospective studies are needed to confirm these findings.

关 键 词：胶质瘤 预后因素 KPS评分 老年 胶质母细胞瘤 

分 类 号：R739.4[医药卫生—肿瘤]