儿童弥漫内生型脑桥胶质瘤预后的影响因素分析  

Analysis of factors influencing the prognosis of diffuse intrinsic pontine glioma in children

作　　者：陈佳树 冀园琦[1] 孙骇浪[1] 杨伟 杨萍 葛明[1] Chen Jiashu;Ji Yuanqi;Sun Hailang;Yang Wei;Yang Ping;Ge Ming(Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院神经外科,北京100045

出　　处：《中华神经外科杂志》2023年第1期19-24,共6页Chinese Journal of Neurosurgery

基　　金：北京市医院管理中心临床医学发展专项(XMLX202144)。

摘　　要：目的初步探讨影响儿童弥漫内生型脑桥胶质瘤(DIPGs)患者预后的相关因素。方法回顾性分析2020年12月至2022年2月首都医科大学附属北京儿童医院神经外科诊治的24例DIPG患儿的临床资料。采用Kaplan-Meier法绘制生存曲线,log-rank检验法分析年龄、性别、病程(≤5周对比>5周)、是否存在外展神经麻痹、病变是否包绕基底动脉和有无强化、是否有脑积水和病变转移、治疗方式以及就诊时的Karnofsky功能状态评分(KPS,>50分对比≤50分)对生存期的影响。将上述部分指标(P<0.1)纳入多因素Cox回归模型中进行分析。结果24例患儿的随访时间为8.2~23.3个月。至末次随访,18例死亡。24例患儿的中位生存期为35.9周(3.0~181.0周);1年生存率为29.2%,2年为4.0%。手术治疗的5例患儿均死亡,中位生存期为12.0周(5.0~77.3周),1年的生存率为20.0%,2年为0。单纯行放化疗的9例患儿,中位生存期为45.0周(11.6~101.9周),1年生存率为55.6%,2年为44.4%。10例姑息治疗的患儿,中位生存期为29.0周(3.1~181.6周),1年生存率为30.0%,2年为10.0%。log-rank检验显示,病程短、病变强化、病变包绕基底动脉、KPS≤50分的患儿生存期短(均P<0.05),而不同性别、年龄、治疗方式,是否有外展神经麻痹、脑积水、病变转移的患儿间生存期差异无统计学意义(均P>0.05)。多因素Cox回归分析显示,病变强化(RR=181.57,95%CI:3.28~10045.64,P=0.011)和较短的病程(RR=0.91,95%CI:0.84~0.99,P=0.024)是降低生存期的重要因素。结论初步研究结果提示,与姑息治疗比较,手术及放化疗不能有效改善DIPGs患儿的预后;病程较短和病变有强化的患儿预后更差。Objective To preliminarily investigate the prognostic factors of diffuse intrinsic pontine gliomas(DIPGs)in children.Methods A retrospective analysis was conducted on the clinical data of 24 children with DIPG who were admitted to the Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University from December 2020 to February 2022.The Kaplan-Meier method was used to draw survival curves.Log-rank test was used to analyze the effects of age,gender,disease duration(≤5 weeks vs.>5 weeks),abducens nerve palsy,whether the lesion was surrounding the basilar artery and whether the tumor was enhanced,hydrocephalus and metastasis,treatment methods and Karnofsky performance status(KPS)score at the time of diagnosis(>50 vs.≤50)on survival.Some of the above indicators(P<0.1)were included in the multivariate Cox regression model for further analysis.Results All patients were followed up for 8.2 to 23.3 months.At the last follow-up,18 patients died.The median survival time of 24 patients was 35.9 weeks(3.0-181.0 weeks),and their survival rate was 29.2%at 1 year and 4.0%at 2 years.All the 5 patients who underwent surgery died.The 5 patients′median survival time was 12.0 weeks(5.0-77.3 weeks),and their 1-year survival rate was 20.0%,and the 2-year survival rate was 0.The median survival time of 9 patients treated with radiotherapy and chemotherapy was 45.0 weeks(11.6-101.9 weeks),and the 1-year survival rate was 55.6%,and the 2-year survival rate was 44.4%.The median survival time of 10 patients receiving palliative treatment was 29.0 weeks(3.1-181.6 weeks),1-year survival rate was 30.0%,and 2-year survival rate was 10.0%.Log-rank test showed that shorter course of disease,lesion enhancement,lesion surrounding the basilar artery,KPS≤50 points were associated with short survival(all P<0.05),while the patient′s gender,age,treatment method,whether there was abducens nerve palsy,hydrocephalus,or tumor metastasis did not seem to affect the survival(all P>0.05).Multivariate Cox regression analysis showed

关 键 词：脑干肿瘤 儿童 预后 危险因素 

分 类 号：R739.41[医药卫生—肿瘤]