不同ATM基因表达水平的小脑幕上弥漫性胶质瘤中放射治疗剂量与生存预后的关系  

The relationship between radiotherapy dose and survival prognosis in diffuse supratentorial gliomas with different ATM gene expression levels

作　　者：刘帅 刘彦伟[1] 刘幸 李一鸣[3] 邱晓光[1] Liu Shuai;Liu Yanwei;Liu Xing;Li Yiming;Qiu Xiaoguang(Department of Radiation Oncology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,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放射治疗科,100070 [2]首都医科大学,北京市神经外科研究所,100070 [3]首都医科大学附属北京天坛医院神经外科,100070

出　　处：《中华神经外科杂志》2021年第5期454-458,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82001778);北京市自然科学基金(7192057)。

摘　　要：目的探讨不同毛细血管扩张性共济失调突变(ATM)基因表达水平的小脑幕上弥漫性胶质瘤患者的放射治疗剂量与生存预后的关系。方法回顾性分析中国脑胶质瘤基因组图谱计划数据库中87例小脑幕上弥漫性胶质瘤患者的转录组数据和临床资料,所有患者均接受三维适形放射治疗或调强适形放射治疗。通过转录组测序检测ATM基因的表达量,按ATM基因表达量的中位数将患者分为高表达组和低表达组。采用单因素和多因素Cox回归分析法判断年龄>40岁、男性、星形细胞瘤、异柠檬酸脱氢酶(IDH)突变型、染色体1p/19q联合缺失以及放射治疗剂量是否为两组患者生存预后的独立影响因素。结果87例患者ATM基因表达量的中位数(四分位数)为15.0(11.1,20.8)。ATM基因低表达组(n=44)患者的放射治疗剂量中位数(四分位数)为54.0(50.4,55.8)Gy;单因素分析结果显示,星形细胞瘤是无进展生存期的危险因素(P=0.036),放射治疗剂量是无进展生存期和总生存期的保护性因素(均P<0.05);多因素Cox回归分析结果显示,星形细胞瘤(HR=4.775,95%CI:1.104~20.652,P=0.036)是无进展生存期的独立危险因素,放射治疗剂量是无进展生存期(HR=0.847,95%CI:0.761~0.942,P=0.002)和总生存期(HR=0.844,95%CI:0.739~0.963,P=0.012)的独立保护性因素。ATM基因高表达组(n=43)患者的放射治疗剂量的中位数(四分位数)为54.0(50.4,57.6)Gy;单因素和多因素Cox回归分析结果均未观察到放射治疗剂量影响无进展生存期和总生存期(均P>0.05)。结论对于ATM基因低表达的患者,增加放射治疗剂量可以改善小脑幕上弥漫性胶质瘤患者的生存预后。Objective To explore the relationship between radiotherapy dose and survival prognosis of patients with supratentorial diffuse glioma with different ataxia telangiectasia mutated(ATM)gene expression levels.Methods The transcriptome data and clinical data of 87 patients with supratentorial diffuse glioma in the Chinese Glioma Genome Atlas database were retrospectively analyzed.All patients received three-dimensional conformal radiotherapy or intensity-modulated conformal radiotherapy.The expression of ATM gene was detected by transcriptome sequencing,and patients were divided into high expression group and low expression group according to the median of ATM gene expression.Univariate and multivariate Cox regression analysis methods were used to determine whether patients aged>40 years old,male,astrocytoma,isocitrate dehydrogenase(IDH)mutation,co-deletion of chromosome 1p/19q,and radiotherapy dose were independent influencing factors of survival prognosis in the two groups of patients.Results The median(quartiles)of ATM gene expression in 87 patients was 15.0(11.1,20.8).The median radiation dose(quartiles)of patients in the ATM gene low expression group(n=44)was 54.0(50.4,55.8)Gy.The results of univariate analysis showed that astrocytoma was a risk factor for progression-free survival(P=0.036);the radiation dose was a protective factor for progression-free survival and overall survival(both P<0.05).The results of multivariate Cox regression analysis showed that astrocytoma(HR=4.775,95%CI:1.104-20.652,P=0.036)was an independent risk factor for progression-free survival;the radiation dose was the independent protective factor for progression-free survival(HR=0.847,95%CI:0.761-0.942,P=0.002)and overall survival(HR=0.844,95%CI:0.739-0.963,P=0.012).The median(quartile)of radiotherapy dose of patients in the ATM gene high expression group(n=43)was 54.0(50.4,57.6)Gy.The results of univariate and multivariate Cox regression analysis revealed that the dose of radiotherapy did not affect progression-free survival or overall

关 键 词：神经胶质瘤 基因表达 放射治疗剂量 预后 毛细血管扩张性共济失调突变 

分 类 号：R739.41[医药卫生—肿瘤]