以癫痫为首发症状的胶质母细胞瘤预后影响因素分析  

Prognostic factors of glioblastoma presenting with epilepsy as a primary symptom

作　　者：李凌[1] 黄红星[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] LI Ling;HUANG Hong-xing;ZOU Shu-cheng(Department of Neurosurgery, Brain Hospital of Hunan Province, Changsha 410007, China)

机构地区：[1]湖南省脑科医院神经外科,长沙410007

出　　处：《临床神经外科杂志》2018年第3期170-173,178,共5页Journal of Clinical 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：目的分析以癫痫为首发症状的胶质母细胞瘤预后的影响因素。方法回顾性分析239例幕上胶质母细胞瘤患者的临床资料。调查收集患者的年龄、性别、首发症状、肿瘤部位、手术切除程度、抗癫痫药物使用,以及术后放化疗,IDH值和总生存期。癫痫患者按抗癫痫药物使用种类分为丙戊酸钠组和其他药物组。结果本组患者中,以癫痫为首发症状者94例,无癫痫发作表现者145例。肿瘤位于额叶76例、顶叶47例、颞叶58例及枕叶58例;全切、次全切和部分切除患者分别为66例、93例和80例。132例患者术后接受完整的放化疗方案,107例患者未能接受完整的放化疗。癫痫组与非癫痫组患者在性别、肿瘤部位、手术切除程度和术后放化疗方面的差异均无统计学意义;而两组患者年龄、IDH突变的差异有统计学意义(均P<0.001)。癫痫组患者的中位生存期为19.93(13.51~26.35)个月,非癫痫组患者中位生存期为12.00(9.32~14.68)个月,差异有统计学意义(P<0.001)。在癫痫患者中,丙戊酸钠组与其他药物组患者的中位生存期的差异无统计学意义(P=0.865)。结论胶质母细胞瘤患者中以癫痫为首发症状者的预后较好;丙戊酸钠对胶质母细胞瘤的预后无明显改善作用。Objective To explore the impact of epilepsy related prognostic factors of glioblastoma. Methods The clinical data of 239 patients with supratentorial glioblastoma from July2006 to July 2016 treated in our hospital were analyzed retrospectively,including age,sex,operation,et al. Among them,we divided the epilepsy drug use into two groups,valproate group and other groups. Results Of 239 patients with supratentorial gliomas,94 had different types of seizures and145 had history of seizures. The tumors were located in frontal lobe in 76 cases,parietal lobe in 47,temporal lobe in 58 and occipital lobe in 58. Total resection,subtotal resection and partial resection were performed in 66,93 and 80 cases respectively. 132 patients received a complete chemoradiotherapy regimen,and 107 failed to receive complete chemoradiotherapy. Median survival in epilepsy was 19. 93（ 13. 51-26. 35） months,whereas median survival was 12（ 9. 32-14. 68）months in non epileptic patients,with significant statistical differences between the two. In patients with epilepsy,valproate use did not significantly improve overall survival. Conclusion The prognosis of patients with glioblastoma is marked by epilepsy. However,there is no improvement in the prognosis of glioblastoma by sodium valproate in this study.

关 键 词：胶质母细胞瘤 癫痫 预后 丙戊酸钠 

分 类 号：R651[医药卫生—外科学]