脊髓高级别星形细胞瘤的临床特征及生存分析  

Clinical features and survival analysis of high-grade astrocytoma of the spinal cord

作　　者：安崧源 张耀武 柴睿超 庞波 闫浩[1] 刘幸[2] 韩波[1] 刘海[1] 徐宇伦[1] 贾文清[1] 王永志[1,2] An Songyuan;Zhang Yaowu;Chai Ruichao;Pang Bo;Yan Hao;Liu Xing;Han Bo;Liu Hai;Xu Yulun;Jia Wenqing;Wang Yongzhi(Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Institute of Neurosurgery,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [2]北京市神经外科研究所,北京100070

出　　处：《中华神经外科杂志》2023年第3期238-243,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82172783);北京市医院管理中心临床医学发展专项(XMLX202109);北京市科技新星计划(Z201100006820118)。

摘　　要：目的分析脊髓高级别星形细胞瘤患者的临床特征及影响生存预后的危险因素。方法回顾性分析2011年3月至2021年12月在首都医科大学附属北京天坛医院神经外科学中心接受手术治疗的96例脊髓高级别星形细胞瘤[世界卫生组织(WHO)3、4级]患者的临床资料。采用Kaplan-Meier法估算生存期及生存率;log-rank检验分析年龄、性别、病程,肿瘤的部位、累及椎体节段长度、切除程度、WHO分级、H3K27M突变及术后辅助放化疗对患者生存期的影响。将上述部分指标(P<0.10)纳入多因素Cox回归模型中进行分析。结果96例患者的中位年龄为35岁(7~63岁),其中18~45岁者占58.3%(56例);中位病程为5.5个月(1~60个月),其中病程≤6个月者占67.7%(65例)。肿瘤好发于脊髓的颈膨大(34.4%,33例)和圆锥(30.2%,29例)。肿瘤累及椎体节段的中位数为3个(1~9个)。51.3%(51例)的患者肿瘤切除程度≥50%。WHO分级4者占81.3%(78例),H3K27M基因突变者占75.0%(72例)。中位随访时间为50.5个月(2.7~133.0个月),失随访8例(8.3%),至末次随访22例患者存活。总体中位生存时间为18.6个月,术后1、2、5年的生存率分别为64%、48%、15%。log-rank检验显示,肿瘤累及椎体节段>3个、WHO 4级和切除程度<50%的患者生存期短(均P<0.05);而患者的年龄、性别、病程、肿瘤的部位、术后辅助放化疗对患者的生存期影响不大(均P>0.05)。多因素Cox回归分析显示,WHO 4级(HR=2.56,95%CI:1.01~6.50,P=0.047)和肿瘤累及椎体节段>3个(HR=1.99,95%CI:1.16~3.42,P=0.024)是患者不良预后的独立危险因素。结论脊髓高级别星形细胞瘤具有一些独特的临床及生物学特征。患者的总体预后差,WHO 4级和肿瘤累及椎体节段>3个的患者预后更差。Objective To analyze the clinical characteristics and risk factors affecting survival of patients with high-grade spinal cord astrocytoma.Methods A retrospective analysis was conducted on the clinical data of 96 patients of spinal cord high-grade astrocytoma(WHO grade 3/4)who underwent surgical treatment at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from March 2011 to December 2021.The Kaplan-Meier method was used to estimate the survival period and survival rate;the log-rank test was used to analyze the effects of age,sex,course of disease,tumor location,length of involved vertebral segments,resection degree,WHO grade,H3K27M mutation and postoperative adjuvant radiotherapy and chemotherapy on survival period.Some of the above indicators(P<0.10)were included in the multivariate Cox regression model for analysis.Results The median age of the 96 patients was 35 years old(7-63 years old),and 58.3%(56)of the patients were 18-45 years old;the median duration of the disease was 5.5 months(1-60 months),and 67.7%(65 cases)of the patients had the duration of disease which was≤6 months.Tumors were more likely to occur in cervical enlargement(34.4%,33 cases)and conus medullaris(30.2%,29 cases)of the spinal cord.The median number of the vertebral segments involved with tumor was 3(1-9)and 51.3%(51 cases)of the patients had the tumor resection degree of≥50%.Those with WHO grade 4 accounted for 81.3%(78 cases),and those with H3K27M gene mutation accounted for 75.0%(72 cases).The median follow-up time was 50.5 months(range:2.7-133.0 months),8 patients(8.3%)were lost to follow-up,and 22 patients(23%)survived at the last follow-up.The overall median survival time was 18.6 months,and the 1-,2-,and 5-year survival rates were 64%,48%,and 15%,respectively.The results of log-rank test showed that patients with the tumor length of>3 vertebral segments,WHO grade 4 tumor and tumor resection degree of<50%had shorter survival time(all P<0.05).The patient′s age,gender,disease duration,tumor location

关 键 词：脊髓肿瘤 神经胶质瘤 疾病特征 预后 危险因素 

分 类 号：R739.42[医药卫生—肿瘤]