高级别脊髓胶质瘤的生存预后及其影响因素分析  

Analysis of survival prognosis and influencing factors of high-grade glioma of the spinal cord

作　　者：荆林凯 于贝贝 张会芳 刘东康[1,2] 满韦韬 杨凯元 孙振兴[1,2] 章薇 王劲[1,2] 王贵怀[1,2] Jing Linkai;Yu Beibei;Zhang Huifang;Liu Dongkang;Man Weitao;Yang Kaiyuan;Sun Zhenxing;Zhang Wei;Wang Jin;Wang Guihuai(Department of Neurosurgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China;School of Clinical Medicine,Tsinghua University,Beijing 100084,China)

机构地区：[1]清华大学附属北京清华长庚医院神经外科,102218 [2]清华大学临床医学院,北京100084

出　　处：《中华神经外科杂志》2021年第12期1251-1256,共6页Chinese Journal of Neurosurgery

基　　金：中国抗癌协会神经肿瘤专业委员会2016"神经肿瘤研究项目"(CSNO-2016-MSD05);首都临床特色应用研究与成果推广项目(Z171100001017199)。

摘　　要：目的探讨高级别脊髓胶质瘤患者的生存预后及其影响因素。方法回顾性分析2015年1月至2020年12月清华大学附属北京清华长庚医院神经外科行肿瘤切除术的48例高级别脊髓胶质瘤[世界卫生组织(WHO)Ⅲ、Ⅳ级]患者的临床资料。术后复查脊柱MRI,判断肿瘤的切除程度。对所有患者行门诊或电话随访,询问其生存状态。采用Kaplan-Meier法绘制高级别脊髓胶质瘤患者的生存曲线。采用单因素和多因素Cox回归法判断影响高级别脊髓胶质瘤患者生存预后的危险因素。结果48例患者术后复查脊柱MRI,7例(14.6%)为肿瘤完全切除,36例(75.0%)为近全切除,5例(10.4%)为部分切除。病理学检查结果显示,18例(37.5%)患者为间变性星形细胞瘤,13例(27.1%)为弥漫性中线胶质瘤,10例(20.8%)为胶质母细胞瘤,7例(14.6%)为间变性室管膜瘤。48例患者的随访时间为(12±6)个月(1~79个月),中位生存时间为12个月(1~79个月),术后1、2、3年的累积生存率分别为56.3%(27/48)、16.7%(8/48)、4.2%(2/48)。多因素Cox回归分析结果显示,病程>6个月(HR=0.393,95%CI:0.160~0.964)、肿瘤完全切除(HR=0.180,95%CI:0.036~0.898)或近全切除(HR=0.246,95%CI:0.064~0.944)是高级别脊髓胶质瘤患者生存预后的保护性因素(均P<0.05),而McCormick评级为Ⅲ、Ⅳ级(HR=2.294,95%CI:1.056~4.986)是影响其生存预后的危险因素(P<0.05)。结论高级别脊髓胶质瘤患者的预后差;病程≤6个月、脊髓功能损伤严重且手术部分切除的患者,生存预后更差。Objective To explore the survival,prognosis and influencing factors of high-grade spinal cord glioma.Methods A retrospective analysis was conducted on the clinical data of 48 patients with high-grade spinal cord glioma(WHO GradeⅢ,Ⅳ)who underwent tumor resection at the Department of Neurosurgery,Beijing Tsinghua Changgung Hospital,Tsinghua University from January 2015 to December 2020.Re-examination of spine MRI was performed after operation to determine the extent of tumor resection.All patients were followed up at outpatient clinics or by telephone and inquired about their survival status.The Kaplan-Meier method was used to draw the survival curve of patients with high-grade spinal cord glioma.Univariate and multivariate Cox regression methods were used to determine the clinical factors affecting patients with high-grade spinal cord glioma.Results In 48 patients,the re-examination of spine MRI was performed after surgery.Total resection was achieved in 7 cases(14.6%),subtotal resection in 36 cases(75.0%),and partial resection in 5 cases(10.4%).Pathological examination results showed that there were 18 cases(37.5%)of anaplastic astrocytoma,13 cases(27.1%)of diffuse midline glioma,10 cases(20.8%)of glioblastoma,and 7 cases(14.6%)of anaplastic ependymoma.The average follow-up period of 48 patients was 12±6 months(1-79 months)and the median survival time was 12 months(1-79 months).At 1 year,2 years and 3 years after the operation,the survival rates were 56.3%(27/48),16.7%(8/48)and 4.2%(2/48)respectively.The results of multivariate Cox regression analysis showed that the course of the disease of more than 6 months(HR=0.393,95%CI:0.160-0.964),total resection(HR=0.180,95%CI:0.036-0.898)and subtotal resection(HR=0.246,95%CI:0.064-0.944)of tumor are protective factors for the survival prognosis of patients with high-grade spinal cord glioma(all P<0.05),and McCormick′s rating ofⅢ,Ⅳ(HR=2.294,95%CI:1.056-4.986)was a risk factor affecting the patient′s survival prognosis(P<0.05).Conclusions The prognosis of pati

关 键 词：神经胶质瘤 脊髓 预后 因素分析 统计学 高级别 

分 类 号：R739.4[医药卫生—肿瘤]