TERTp和1p/19q对顺铂联合替莫唑胺同期放化疗治疗MGMT启动子未甲基化GBM的预后影响  

Prognostic value of TERTp and 1p/19q in cisplatin combined with temozolomide concurrent chemoradiotherapy for newly diagnosed GBM with unmethylated MGMT promoter

作　　者：高洪元 张玺炜 汪洋[2] 盛晓芳[2] 吴学勇 殷晓峰 陈淑[2] 倪春霞[2] 孟歌[2] 胡莉 王宝红 GAO Hong-yuan;ZHANG Xi-wei;WANG Yang(Department of Oncology,Jing an District Central Hospital,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]上海市静安区中心医院(复旦大学附属华山医院静安分院)肿瘤科,上海200040 [2]复旦大学附属华山医院上海伽玛医院放疗中心,上海200040

出　　处：《临床神经外科杂志》2019年第4期289-293,共5页Journal of Clinical Neurosurgery

基　　金：上海市科学技术委员会医学引导类西医科技支撑项目(16411972300)

摘　　要：目的 探讨TERTp和1p/19q不同表型对DDP联合TMZ同期放化疗治疗新诊断 MGMT启动子未甲基化GBM的预后影响。方法 回顾性分析73例新诊断MGMT启动子未甲基化的GBM的临床资料,均接受DDP联合TMZ同期放化疗,行TERTp和1p/19q检测,分析TERTp和1p/19q不同表型的临床特征、副反应、PFS和OS。结果 根据TERTp分为 TERTp wt 30例和TERTp mut 43例,根据1p/19q分为无缺失组62例和缺失组11例,临床资料差异均无统计学意义( P >0.05)。截至2019年1月31日,44例复发,其中TERTp wt 17例、TERTp mut 27例,中位PFS为12.0个月和10.0个月,1年PFS率为33.6%和27.2%。22例死亡,其中TERTp wt 9例、TERTp mut 13例,中位OS为20.0个月和19.0个月,1年OS率为77.9%和 73.2 %,差异无统计学意义。1p/19q无缺失组复发38例,缺失组复发6例,中位PFS为10.0个月与22.0个月,1年PFS率为20.4%和60.0%,差异无统计学意义。1p/19q无缺失组死亡19例,缺失组死亡3例,中位OS为18.0个月和23.0个月;1年OS率为60.3%和88.9%。1p/19q缺失组疗效有高于无缺失组的趋势,但差异无统计学意义。结论 DDP联合TMZ同期放化疗治疗MGMT启动子未甲基化新诊断GBM,TERTp wt疗效略高于TERTp mut,1p/19q缺失组疗效有高于无缺失组的趋势,但差异未达到统计学意义。1p/19q可能在MGMT启动子未甲基化新诊断GBM接受DDP联合TMZ同期放化疗中有潜在的影响预后价值,值得进一步研究。Objective To investigate the clinical characteristics and prognostic value of TERTp and 1p/19q phenotype in DDP+TMZ concurrent chemoradiotherapy for newly diagnosed GBM with unmethylated MGMT promoter.Methods A retrospective analysis was made in 73 newly diagnosed GBM with unmethylated MGMT promoter.All patients received DDP+TMZ .The aim of this study was to analyze the clinical characteristics,adverse reactions,PFS and OS of patients with different TERTp and 1p/19q groups.Results According to TERTp,there were 30 cases of TERTp wt and 43 cases of TERTp mut.According to 1p/19q,62 cases were non-deletion and 11 cases were deletion.There was no significant difference in clinical parameters between two groups(P>0.05 ).Up to 31st January 2019,44 patients had recurrence,17 with TERTp wt and 27 with TERTp mut.The median PFS was 12.0 and 10.0 months,respectively.The 1-year PFS rate was 33.6% and 27.2%.22 patients died,9 with TERTp wt and 13 with TERTp mut.The median OS was 20.0 and 19.0 months.The 1-year OS rate was 77.9% and 73.2%.There were 38 recurrences in 1p/19q non-deletion and 6 recurrences in deletion.The median PFS was 10.0 and 22.0 months respectively.The 1-year PFS rate was 20.4% and 60.0%.There were 19 deaths with 1p/19q non-deletion,3 deaths in deletion,and the median OS was 18.0 and 23.0 months.The 1-year OS rates were 60.3% and 88.9%.There was a better trend in the efficacy for 1p/19q non-deletion than that of deletion.But the difference was not significant.Conclusion The efficacy of TERTp wt is slightly higher than that of TERTp mut.The efficacy of 1p/19q deletion group is higher than that of non-deletion,but the difference is not statistically significant.1p/19q may have potential prognostic value in newly diagnosed GBM with unmethylated MGMT promoter receiving DDP +TMZ concurrent chemoradiotherapy,which deserves further study.

关 键 词：胶质母细胞瘤 O6-甲基鸟嘌呤-DNA甲基转移酶启动子未甲基化 端粒酶逆转录酶 1p/19q 顺铂 替莫唑胺 

分 类 号：R739.41[医药卫生—肿瘤]