78例脑胶质母细胞瘤术后同步放化疗患者的生存影响因素  

Analysis of survival factors in 78 patients with glioblastoma undergoing radio-chemotherapy following surgery

作　　者：方金梅 赵于飞 龙腾飞 刘云[1] 方晶 吴爱林[1] FANF Jinmei;ZHAO Yufei;LONG Tengfei;LIU Yun;FANG Jing;WU Ailing(Department of Radiotherapy,the First Affiliated Hospitalof USTC West District(Anhui Provincial Cancer Hospital),Hefei 230031,China;Departmentof Radiotherapy,Ion Medical Centre of the First Affiliated Hospital of USTC(Hefei Ion Medical Centre),Hefei 230088,China)

机构地区：[1]中国科学技术大学附属第一医院西区(安徽省肿瘤医院)放疗科,安徽合肥230031 [2]中国科学技术大学附属第一医院离子医学中心(合肥离子医学中心)放疗科,安徽合肥230088

出　　处：《安徽医学》2022年第1期6-10,共5页Anhui Medical Journal

基　　金：国家自然科学基金资助项目(项目编号:11805198)。

摘　　要：目的探讨脑胶质母细胞瘤术后同步放化疗患者预后的影响因素。方法选取2015年6月30日至2017年12月13日在安徽省肿瘤医院完成同步放化疗的78例胶质母细胞瘤术后患者,回顾分析其一般临床特征、放疗剂量、辅助替莫唑胺化疗疗程、术中脑胶质母细胞瘤切除情况以及免疫组化相关指标对患者无进展生存期(PFS)及总生存期(OS)的影响。用生命表法绘制PFS及OS生存曲线;用Kaplan-Meier评估生存率的差异,Log-rank检验法进行单因素生存分析;将单因素分析中具有统计学意义的变量纳入多因素Cox比例风险模型筛选生存影响因素。结果78例胶质母细胞瘤患者的单因素分析发现,患者放疗前KPS评分>60分、术中肿瘤全切、辅助替莫唑胺化疗疗程数>6个周期可能延长患者的PFS及OS,差异均有统计学意义(P<0.001);而患者的性别、年龄、放疗剂量、IDH1突变情况、MGMT状态、Ki-67表达情况对患者PFS、OS无明显影响(P>0.05);单因素分析中有统计学意义的3个变量,其生存曲线图均无明显相交满足PH假设。将3个变量纳入多因素Cox回归分析,KPS评分、术中是否全切、辅助替莫唑胺化疗周期数对延长患者的OS均有存在影响(P<0.05);KPS评分和术中是否全切对患者PFS的延长差异有统计学意义(P=0.005、0.003),而辅助替莫唑胺化疗周期数对延长PFS差异无统计学意义(P=0.109)。结论放疗前KPS评分、术中切除情况、辅助化疗周期数是胶质母细胞瘤患者术后独立预后影响因素,KPS评分越高、术中全切、辅助化疗周期延长可明显改善患者的OS。Objective To investigate the clinical characteristics and prognostic factors for patients with glioblastoma.Methods The clinical data of 78 patients with glioblastoma(GBM)undergoing radio-chemotherapy following surgery from June 30,2015 to December 13,2017 in Anhui Provincial Cancer Hospital were analyzed retrospectively,including radiation doses,the number of adjuvant temozolomide(TMZ)cycles,extent of surgical resection,and immunohistochemical index.Kaplan-Meier method was performedto assess the survival rate.Cox regression model was used to analyze prognostic factors.Results Univariate analysis showed that KPS score before radiotherapy>60,gross total resection of tumor,and more than 6 cycles of adjuvant TMZ were significantly associated with longer progression-free survival(PFS)and the median overall survival time(OS)time of 78 patients with GBM(P<0.001),whereas the gender,age,radiation doses,the expression of IDH1,MGMT and Ki-67 had no significant impact on the PFS(P>0.05),and no significant effect on OS(P>0.05).There werethree variables with statistical significance in univariate analysis.None of their survival curves intersected significantly,which could be considered to meet the PH hypothesis.There variables were incorporated into multivariate Cox regression analysis,andin terms of OS,KPS score was statistically significant for the extension of OS(P<0.05).Moreover,KPS score and the extent of total resection significantly impacted the PFS(P=0.005、0.003,respectively)while the number of adjuvant TMZ cycles had no significant effect(P=0.109).Conclusions KPS score before radiotherapy,intraoperative resection,and the number of adjuvant chemotherapy cycles are independent prognostic factors for patients with glioblastoma.The higher KPS score,the intraoperative total resection,and the prolonged adjuvant chemotherapy cycle can significantly improve the patients’OS.

关 键 词：胶质母细胞瘤 同步放化疗 生存因素 

分 类 号：R739.41[医药卫生—肿瘤]