基于分子分型的髓母细胞瘤复发相关影响因素分析  

Analysis of risk factors of medulloblastoma recurrence based on the molecular subgroups

作　　者：刘海龙 田雨 王嘉义 李亚农[1] 冯谨 李春德[3] 姜涛[3] 邱晓光[1] LIU Hai-long;TIAN Yu;WANG Jia-yi;LI Ya-nong;FENG Jin;LI Chun-de;JIANG Tao;QIU Xiao-guang(Department of Radiotherapy,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;School of Public Health,Capital Medical University,Beijing 100069,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]首都医科大学公共卫生学院,北京100069 [3]首都医科大学附属北京天坛医院神经外科,100070

出　　处：《中国现代神经疾病杂志》2021年第12期1095-1102,共8页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号:81902975);首都卫生发展科研专项(项目编号:2020-2-1072)。

摘　　要：目的分析基于分子分型的髓母细胞瘤复发率并筛查其相关危险因素。方法纳入2011年3月至2013年11月首都医科大学附属北京天坛医院收治并经术后病理证实的67例髓母细胞瘤患者,均行MRI检查(包括肿瘤部位、肿瘤浸润程度、肿瘤播散、肿瘤分期、手术切除程度)以及病理学检查(包括组织学分型和分子分型),记录复发率。绘制Kaplan-Meier生存曲线,采用单因素和多因素Cox回归分析筛查髓母细胞瘤复发相关危险因素。结果共67例髓母细胞瘤患者,总生存率为71.64%(48/67),无进展生存率为67.16%(45/67)、复发率为32.84%(22/67),病死率为28.36%(19/67),其中复发组病死率显著高于未复发组[81.82%(18/22)对2.22%(1/45);χ^(2)=46.078,P=0.000]。Kaplan-Meier生存曲线显示,外侧型患者中位生存期短于中央型(18个月对51个月,P=0.000),大细胞型/间变性患者中位生存期短于经典型、促纤维增生/结节型、广泛结节型(10个月对50、44和31个月,P=0.000),SHH活化型患者中位生存期短于WNT活化型、3组型、4组型(19个月对32、33和57个月,P=0.003),复发患者中位生存期短于未复发患者(19个月对60个月,P=0.000)。多因素Cox回归分析显示,外侧型(RR=3.514,95%CI:1.262~9.781;P=0.016)、大细胞型/间变性(RR=6.452,95%CI:1.320~31.537;P=0.021)和3组型(RR=4.289,95%CI:1.359~13.533;P=0.013)是髓母细胞瘤复发的危险因素。结论外侧型、大细胞型/间变性组织学亚型、SHH型分子亚型和复发性髓母细胞瘤的生存期更短,且外侧型、大细胞型/间变性组织学亚型和3组型分子亚型髓母细胞瘤更易复发。Objective To investigate the recurrence rate and risk factors for the patients with medulloblastoma based on the molecular subgroups.MethodsA retrospective study was conducted for the clinicopathological data of 67 medulloblastoma patients who were admitted in Department of Radiotherapy and Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from March 2011 to November 2013.All the cases received the MRI examinations to identify the location,aggressiveness,dissemination,stage and resection as well as the histological and molecular pathology in order to analyze the recurrence rate.The Kaplan-Meier survival curve and Cox regression were performed to detect the risk factors for medulloblastoma recurrences.Based on the recurrence,this cohort of samples were divided into recurrence group(n=22)and non-recurrence group(n=45).Results Among the patients,the overal lsurvival rate was 71.64%(48/67),the progression-free survival rate was 67.16%(45/67),the recurrece rate was 32.84%(22/67),and the fatality rate was 28.36%(19/67).The fatality rate in the recurrence group was significantly higher than that in the non-recurrence group[81.82%(18/22)vs.2.22%(1/45);χ^(2)=46.078,P=0.000].The Kaplan-Meier survival curves showed that patients with lateral medulloblastoma have a shorter median survival time than those with middle medulloblastoma(18 months vs.51 months,P=0.000),patients with large cell/anaplasitc medulloblastoma suffered from a poorer median survival time compared with the classic medulloblastoma,desmoplastic/nodular medulloblastoma and medulloblastoma with extensive nodularity(10 months vs.50,44 and 31 months;P=0.000),median survival time of patients with SHH-activated subtype was shorter than that of patients with the other three subgroups(19 months vs.32,33 and 57 months;P=0.003),and median survial time of patients with recurrence was shorter than that of patients with non-recurrence(19 months vs.60 months,P=0.000).The Cox regression analysis showed that lateral medulloblastoma(RR=3.514,95%CI:1.262-9.781

关 键 词：髓母细胞瘤 生物标记 肿瘤 肿瘤复发 局部 存活率分析 危险因素 回归分析 

分 类 号：R739.4[医药卫生—肿瘤]