WHOⅡ级脑胶质瘤患者无进展生存期的影响因素分析  

Analysis of risk factors influencing the progression-free survival in WHO Ⅱ grade gliomas

作　　者：张东旭 曲彦明[1] 张明山[1] 任铭[1] 谷春雨[1] 王浩然[1] 宁威海 郭玉铎 齐雪岭[1] 张宏伟[1] Zhang Dongxu;Qu Yanming;Zhang Mingshan;Ren Ming;Gu Chunyu;Wang Haoran;Ning Weihai;Guo Yuduo;Qi Xueling;Zhang Hongwei(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China;Department of Neurosurgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093 [2]首都医科大学附属北京潞河医院神经外科,101149

出　　处：《中华神经外科杂志》2019年第5期469-473,共5页Chinese Journal of Neurosurgery

摘　　要：目的分析世界卫生组织(WHO)Ⅱ级脑胶质瘤患者无进展生存期的影响因素。方法回顾性纳入2008年1月至2015年12月首都医科大学三博脑科医院神经外科收治的72例成人WHOⅡ级脑胶质瘤患者,对患者行手术切除肿瘤。术后对组织样本采用免疫组织化学染色方法检测异柠檬酸脱氢酶1(IDH1)R132H、α地中海贫血或精神发育迟滞综合征X染色体相关基因(ATRX)及端粒延长酶调节因子1(RTEL1)的突变情况。采用Kaplan-Meier生存曲线分析IDH1 R132H、ATRX及RTEL1表达不同的患者无进展生存期的差异。采用单因素和多因素Cox回归分析方法进一步评价影响患者预后的各临床因素。结果72例脑胶质瘤患者免疫组织化学染色结果为,39例(54.2%)IDH1 R132H染色阳性,33例(45.8%)阴性;56例(77.8%)ATRX染色阴性,16例(22.2%)阳性;29例(40.3%)RTEL1染色阳性,43例(59.7%)阴性。生存期分析结果显示,IDH1 R132H阴性患者的累积无进展生存率低于IDH1 R132H阳性者(P<0.05),ATRX阳性与阴性患者累积无进展生存率间的差异无统计学意义(P>0.05),RTEL1阳性患者的累积无进展生存率低于RTEL1阴性患者(P<0.05)。单因素和多因素Cox回归分析结果显示,年龄>40岁(OR=3.618,95%CI:1.688~7.753,P=0.001)、肿瘤部分切除(OR=0.204,95%CI:0.064~0.656,P=0.008)、IDH1R132H表达阴性(OR=2.867,95%CI:1.129~7.282,P=0.027)及RTEL1表达阳性(OR=0.354,95%CI:0.151~0.827,P=0.016)为胶质瘤患者无进展生存期的独立影响因素,可独立用于患者的预后判断。结论年龄>40岁、肿瘤部分切除、IDH1R132H表达阴性及RTEL1表达阳性是影响WHOⅡ级脑胶质瘤患者无进展生存期的独立危险因素。Objective To investigate the risk factors that influence the progression-free survival (PFS) in WHO Ⅱ-grade gliomas in adults. Methods Clinical data obtained from 72 patients with WHO Ⅱ grade gliomas undergoing surgical resection between January 2008 and December 2015 at Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University were analyzed. Immunohistochemistry staining method was employed to detect mutation of isocitrate dehydrogenase 1(IDH1) R132H,α thalassemia/mental retardation syndrome X-linked(ATRX) and the expression of regulator of telomere elongation helicase 1(RTEL1). Survival analysis was estimated by Kaplan-Meier analysis. Cox regression modelling was used for univariate analysis and multivariate analysis. Results The results of immunohistochemical staining in 72 patients with gliomas revealed 39 (54.2%) cases of IDH1 R132H mutant positive, 33 (45.8%) cases of negative;56 (77.8%) cases of ATRX missing mutant negative, 16 (22.2%) cases of positive;29 (40.3%) cases of RTEL1 positive and 43 (59.7%) cases of negative. The results of survival analysis showed that the cumulative PFS rate of IDH1 R132H negative patients was lower than that of IDH1 R132H positive(P<0.05). There was no statistically significant difference in PFS rate between the ATRX positive and negative patients (P>0.05). The cumulative PFS rate of RTEL1 positive patients was lower than that of RTEL1 negative patients (P<0.05). Univariate and multivariate Cox regression analysis showed that age >40 years (OR=3.618, 95% CI: 1.688-7.753, P=0.001), partial resection (OR=0.204, 95% CI: 0.064-0.656, P=0.008), expression of IDH1 R132H negative (OR=2.867, 95% CI: 1.129-7.282, P=0.027) and RTEL1 positive (OR=0.354, 95% CI: 0.151-0.827, P=0.016) were independent factors influencing PFS of glioma patients, and could be independently used for prognostic judgment of glioma patients. Conclusion Age (>40 years), degree of tumor resection (partial resection), expression of IDH1 R132H (negative) and RTEL1 expression (positive) are

关 键 词：神经胶质瘤 无进展生存期 异柠檬酸脱氢酶1 α地中海贫血或精神发育迟滞综合征X染色体相关基因 端粒延长酶调节因子1 

分 类 号：R739.41[医药卫生—肿瘤]