成人幕上间变性胶质瘤预后评分量表的建立  

A prognostic scoring scale for adult patients with supratentorial primary anaplastic gliomas

作　　者：娄平阳[1] 吴中华[1] 赵亚军 郭杨 王斌[1] Lou Pingyang;Wu Zhonghua;Zhao Yajun;Guo Yang;Wang Bin(Department of Neurosurgery. Henan Provincial People's Hospital, Zhengzhou 450000, China)

机构地区：[1]河南省人民医院神经外科,郑州450000

出　　处：《中华医学杂志》2019年第9期690-694,共5页National Medical Journal of China

摘　　要：目的 探讨影响幕上间变性胶质瘤患者预后的相关因素,拟制定一份预后评分量表,为临床治疗提供理论参考.方法 收集2009年1月至2018年1月河南省人民医院神经外科手术治疗的198例原发间变性胶质瘤患者的临床资料.单因素生存分析采用Kaplan-Meier法,多因素分析使用Cox比例风险模型,筛选预后相关因素,并利用预后因素制定一份预后评分量表.结果 单因素分析结果显示年龄、肿瘤部位、肿瘤直径、术前KPS、切除程度、放疗、化疗、病理含少突成分、1p/19q、IDH、MGMT与患者预后显著相关(P<0.05);多因素分析结果显示年龄≥45岁、肿瘤直径≥6 cm、术前KPS<70、未放疗、1p/19q未缺失、MGMT启动子非甲基化均为独立预后危险因子(P<0.05).每项独立预后危险因子给予评价1分,患者评分则为0~6分;依据评分将患者分组,其中<2分者为低危组、2分者为中危组、3分者为高危组,≥4分者为极高危组,不同组别患者生存期差异有统计学意义(P<0.000 1).结论 患者评分越高,预后越差;该预后评分量表可以为间变性胶质瘤患者预后判断提供理论依据,有助于开展个体化临床治疗.Objective This study explored the prognostic factors of patients with supratentorial anaplastic gliomas and tried to propose a prognostic scoring scale with aim to provide theoretical reference for clinical treatment.Methods The clinical data of 198 patients surgically treated for primary anaplastic glioma in Henan Provincial People's Hospital between Jan 2009 and Jan 2018 were reviewed.Univariate and multivariate analyses were used to identify prognostic factors with methods of Kaplan-Meier plot and Cox proportional hazard model,respectively.Based on the prognostic factors,a scoring scale was thereby proposed.Results Univariate analysis results showed age,tumor location,tumor diameter,preoperative KPS,extent of resection,radiotherapy,chemotherapy,pathology with oligodendroglial components,1p/19q,IDH,MGMT were significantly correlated with survival (P<0.05).Multivariate analysis results showed age ≥45 years old,tumor diameter ≥6 cm,preoperative KPS<70,without radiotherapy,1p/19q intact,MGMT promoter unmethylation were independent prognostic risk factors (P<0.05).Patients were scored with 0-6 points based on the formulation that each independent prognostic risk factor was assigned with 1 point.Then patients were further grouped according to the score.Those with less than 2 points were low-risk group,equal to 2 points were medium-risk group,equal to 3 points were high-risk group,more than or equal to 4 points were extremely high-risk group.There were significant differences in survival between the different groups (P<0.000 1).Conclusions The higher score,the shorter survival time.This prognostic scoring scale can provide a theoretical basis for the prognosis estimation of patients with anaplastic glioma and help to carry out personalized clinical treatment.

关 键 词：间变性胶质瘤 分子标记物 预后 量表 

分 类 号：R739.41[医药卫生—肿瘤]