胶质肉瘤的临床特点及预后因素分析  

Clinical features and prognostic factor analysis of gliosarcomas

作　　者：张国滨[1] 黄华玮 任晓辉[1] 崔勇[1] 隋大立[1] 姜中利[1] 林松[1] 王永刚[1] Zhang Guobin;Huang Huawei;Ren Xiaohui;Cui Yong;Sui Dali;Jiang Zhongli;Lin Song;Wang Yonggang(Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China;Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100070 [2]首都医科大学附属北京天坛医院重症医学科,100070

出　　处：《中华神经外科杂志》2019年第4期363-367,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨胶质肉瘤的临床特点及其预后影响因素。方法回顾性纳入2008年1月至2018年1月首都医科大学附属北京天坛医院神经外科行手术治疗的188例胶质肉瘤患者,占同期胶质母细胞瘤患者的5.15%(188/3647)。术后采取临床随访和影像学随访,了解患者的无进展生存期(PFS)、总生存期(OS)和肿瘤复发转移的情况。采用单因素Log-rank分析和多因素Cox回归分析影响患者预后的因素。结果188例胶质肉瘤患者中,全切除143例,近全切除37例,部分切除8例。其中169例术后行放、化疗,13例仅行放疗,6例未行放、化疗。中位随访时间为15个月(3~28个月)。中位PFS为8个月(3~18个月),中位OS为15个月(4~28个月)。单因素Log-rank分析显示,年龄、肿瘤切除程度以及术后是否进行辅助放、化疗均为OS和PFS的影响因素(均P<0.05);性别、术前Karnofsky功能状态评分以及O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)启动子甲基化均非OS及PFS的影响因素(均P>0.05)。单因素及多因素Cox回归分析显示,年龄、肿瘤切除程度以及术后辅助放、化疗均是影响患者OS和PFS(均P<0.05)的独立影响因素。结论胶质肉瘤临床罕见且预后极差。年龄<60岁、手术全切除肿瘤以及术后辅助放、化疗者的生存期明显延长。Objective To discuss the clinical characteristics and prognostic factors of gliosarcomas. Methods A total of 188 patients with primary gliosarcomas who underwent surgical treatment from January 2008 to January 2018 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were retrospectively analyzed.The incidence of gliosarcoma among the gliosarcoma and glioblastoma was 5.15%(188/3 647). The clinical features were summarized and influencing factors of outcomes including progression-free survival (PFS), overall survival (OS) and tumor recurrence and metastasis were investigated.Univariate Log-rank analysis and multivariate Cox regression analysis were used to analyze the factors. Results Among the 188 patients, gross total resection was achieved in 143 patients, sub-total resection in 37 and partial resection in 8. After surgery, 169 patients received radiotherapy and chemotherapy, 13 received radiotherapy only and 6 did not undergo radiotherapy or chemotherapy. The median follow-up period was 15 months (range: 3-28 months). The median OS was 15 months(range: 4-28 months), and the median PFS was 8 months(range: 3-18 months). Log-rank univariate analysis showed that age, extent of tumor resection and postoperative radiotherapy and chemotherapy were influencing factors for OS and PFS (all P<0.05). The OS and PFS had no correlation with gender, preoperative Karnofsky performance scale (KPS) or MGMT methylation (all P>0.05). Univariate and multivariate Cox regression analysis showed that age, extent of tumor resection and postoperative radiotherapy and chemotherapy affected the OS and PFS of the patients (all P<0.05). Conclusions Gliosarcoma is rare and its prognosis seems poor. The age < 60 and maximum tumor resection combined with postoperative adjuvant radiotherapy and chemotherapy could prolong the survival of patients.

关 键 词：胶质肉瘤 临床特点 预后 影响因素分析 

分 类 号：R739.41[医药卫生—肿瘤]