手术治疗巨大侵袭性垂体腺瘤的预后影响因素分析  

Analysis of prognostic factors in surgical treatment of giant invasive pituitary adenomas

作　　者：沈阳 宁威海 曲彦明[1] 张明山[1] 王浩然[1] 谷春雨[1] 于春江[1] 张宏伟[1] Shen Yang;Ning Weihai;Qu Yanming;Zhang Mingshan;Wang Haoran;Gu Chunyu;Yu Chunjiang;Zhang Hongwei(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,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

出　　处：《中华神经外科杂志》2021年第5期443-448,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨手术治疗巨大侵袭性垂体腺瘤的预后影响因素。方法回顾性分析2011年4月至2016年12月首都医科大学三博脑科医院神经外科行手术治疗的84例巨大侵袭性垂体腺瘤患者的临床资料。采用单因素和多因素logistic回归分析探讨肿瘤切除程度的影响因素。采用Kaplan-Meier生存分析和多因素Cox回归分析探讨影响术后肿瘤进展的因素。结果84例患者中,肿瘤全切除13例(15.5%),近全切除40例(47.6%),次全切除31例(36.9%)。89.3%(75/84)的患者获得随访,随访时间为15~83(46.8±19.0)个月。围手术期无一例患者死亡,术后3个月内2例(2.4%)死于手术并发症。单因素分析结果显示,既往有手术或放疗史、肿瘤的最大径、肿瘤的形状、肿瘤对海绵窦的侵袭程度、肿瘤是否侵入后颅窝、MRI显示的病灶强化特点以及肿瘤的质地均可能影响巨大侵袭性垂体腺瘤的切除程度(均P<0.05)。多因素logistic回归分析结果显示,肿瘤对海绵窦的侵袭程度(OR=0.089,95%CI:0.009~0.850,P=0.036)、肿瘤的质地(OR=0.246,95%CI:0.077~0.786,P=0.018)是影响肿瘤切除程度的独立危险因素。84例患者中,随访期内肿瘤进展14例。Log-rank分析结果表明,肿瘤切除程度、病理学检查可见核分裂象、Ki-67指数均可能与肿瘤进展有关(均P<0.05)。多因素Cox分析结果表明,肿瘤切除程度(HR=0.316,95%CI:0.107~0.932,P=0.037)为肿瘤进展的保护性因素,病理学检查可见核分裂象(HR=5.064,95%CI:1.726~14.859,P=0.003)是影响肿瘤进展的独立危险因素。结论对于巨大侵袭性垂体腺瘤患者,海绵窦侵袭程度高(Knosp分级为3~4级)、质地硬韧的肿瘤不易达到全切除。切除程度高的肿瘤不易发生进展,而病理学检查可见核分裂象的肿瘤容易发生进展。Objective To investigate the factors influencing prognosis of patients with giant invasive pituitary adenomas who underwent surgical treatment.Methods Clinical data of 84 patients with giant invasive pituitary adenomas who underwent surgical treatment at Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University from April 2011 to December 2016 were retrospectively analyzed.Univariate and multivariate logistic regression analysis were used to explore the influencing factors of the degree of tumor resection.Kaplan-Meier analysis and multivariate Cox regression analysis were used to investigate the influencing factors of tumor progression.Results Among 84 patients,total resection was achieved in 13 cases(15.5%),near-total resection in 40 cases(47.6%)and subtotal resection in 31 cases(36.9%).There were 89.3%(75/84)of the patients who had been followed up for 15-83 months(46.8±19.0 months).There was no perioperative death,and 2 patients(2.4%)died due to surgical complications within 3 months.Univariate analysis showed that previous surgery or radiotherapy,maximal diameter of tumor,tumor shape,tumor invasion degree to the cavernous sinus,whether the tumor invaded the posterior cranial fossa,the enhancement characteristics of the lesions on MRI and the tumor texture could affect the degree of tumor resection(all P<0.05).Multivariate logistic regression analysis showed that the tumor invasion degree to the cavernous sinus(OR=0.089,95%CI:0.009-0.850,P=0.036)and tumor texture(OR=0.246,95%CI:0.077-0.786,P=0.018)were independent risk factors for tumor resection.Among 84 patients,14 cases had tumor progression during the follow-up period.Log-rank analysis showed that the tumor resection degree,the presence of mitosis and Ki-67 index in pathological examination might be related to tumor progression(all P<0.05).Multivariate Cox analysis showed that the tumor resection degree(HR=0.316,95%CI:0.107-0.932,P=0.037)was a protective factor for tumor progression,and the presence of mitosis(HR=5.064,95%CI:1.726-14.859,

关 键 词：垂体肿瘤 神经外科手术 预后 巨大 危险因素 

分 类 号：R736.4[医药卫生—肿瘤]