复发成人型弥漫性脑胶质瘤患者生存预后的影响因素分析  

Prognostic factors for survival in patients with recurrent adult-type diffuse brain gliomas

作　　者：李冠璋 晋强[2] 张忠[2] 钱增辉[2] 李一鸣[2] 刘令宇 董佳涵 徐孟辉 张伟[2] Li Guanzhang;Jin Qiang;Zhang Zhong;Qian Zenghui;Li Yiming;Liu Lingyu;Dong Jiahan;Xu Menghui;Zhang Wei(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

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

出　　处：《中华神经外科杂志》2025年第3期221-226,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82202896,82072768);北京市自然科学基金(JQ24057)。

摘　　要：目的探讨复发成人型弥漫性脑胶质瘤患者生存预后的影响因素。方法回顾性分析中国脑胶质瘤基因组图谱计划(CGGA)数据库中2006年1月至2021年6月接受肿瘤切除术且术后随访资料完整的468例复发成人型弥漫性脑胶质瘤患者的临床数据。所有患者均依据第五版世界卫生组织(WHO)中枢神经系统肿瘤分类标准进行诊断,其中复发异柠檬酸脱氢酶(IDH)突变型星形细胞瘤患者217例,复发IDH突变伴1p/19q联合缺失型少突胶质细胞瘤患者64例,复发IDH野生型胶质母细胞瘤患者187例。应用单因素和多因素Cox比例风险回归模型(输入法)进行生存分析,将单因素分析中P<0.05的因素纳入多因素Cox比例风险回归模型。结果复发IDH突变型星形细胞瘤患者中,WHO分级2、3、4级患者的中位总生存期(OS)分别为118.4、18.8、11.5个月,中位无进展生存期(PFS)分别为42.8、17.2、8.5个月;复发IDH突变伴1p/19q联合缺失型少突胶质细胞瘤,WHO分级2、3级患者的中位OS分别为70.6、61.7个月,中位PFS分别为54.3、42.8个月;复发IDH野生型胶质母细胞瘤患者的中位OS和PFS分别为9.0、6.9个月。单因素和多因素Cox比例风险回归模型分析结果显示,性别、年龄、O 6-甲基鸟嘌呤-DNA甲基转移酶启动子甲基化和术前癫痫发作均非3种类型脑胶质瘤患者OS和PFS的影响因素(均P>0.05),而肿瘤全切除为3种类型脑胶质瘤患者OS(单因素分析HR为0.300~0.385,多因素分析HR为0.360~0.388)和PFS(单因素分析HR为0.395~0.469,多因素分析HR为0.393~0.436)的保护性因素(均P<0.05);更高的WHO分级为复发IDH突变型星形细胞瘤患者OS(多因素分析HR=2.170,95%CI:1.710~2.753)和PFS(多因素分析HR=2.131,95%CI:1.695~2.679)的危险因素(均P<0.001);术后癫痫发作为复发IDH野生型胶质母细胞瘤患者OS(多因素分析HR=0.505,95%CI:0.321~0.794)和PFS(多因素分析HR=0.542,95%CI:0.348~0.845)的保护性因素(均P<0.05)。结论3种类型�ObjectiveTo explore the prognostic factors of recurrent adult-type diffuse brain gliomas.MethodsBased on the Chinese Glioma Genome Atlas(CGGA)Database,a total of 468 patients with recurrent adult-type diffuse brain gliomas were retrospectively enrolled into this study.All patients underwent surgery from January 2006 to June 2021 and received regular follow-up after surgery.All patients were diagnosed according to the fifth edition of the World Health Organization(WHO)classification of tumors of the central nervous system(CNS),including 217 patients with recurrent astrocytoma,isocitrate dehydrogenase(IDH)-mutant;64 patients with recurrent oligodendroglioma,IDH-mutant with 1p/19q codeleted;and 187 patients with recurrent glioblastoma,IDH wild-type.Univariate and multivariate Cox proportional hazards regression models were applied for survival analysis,and factors with P<0.05 in the univariate analysis were included in the multivariate Cox proportional hazards regression model.ResultsFor patients with recurrent astrocytoma,IDH-mutant,the median overall survival(OS)of WHO CNS grades 2,3,and 4 were 118.4,18.8 and 11.5 months,respectively,and the median progression-free survival(PFS)were 42.8,17.2 and 8.5 months,respectively.For patients with recurrent oligodendroglioma,IDH-mutant with 1p/19q codeleted,WHO CNS grades 2 and 3,the median OS were 70.6 and 61.7 months,respectively,and the median PFS were 54.3 and 42.8 months,respectively.For patients with recurrent glioblastoma,IDH wild-type,the median OS and median PFS were 9.0 and 6.9 months,respectively.The results of univariate and multivariate Cox proportional hazards regression model analysis showed that gender,age,O 6-methylguanine-DNA methyltransferase promoter methylation,or preoperative epileptic seizure was not prognostic factor for OS and PFS in the three types of patients with brain gliomas(all P>0.05),while gross total tumor resection was a protective factor for OS(univariate analysis HR:0.300-0.385,multivariate analysis HR:0.360-0.388)and PFS(univariate anal

关 键 词：神经胶质瘤 复发 预后 影响因素分析 病理学 分子 成人型弥漫性胶质瘤 

分 类 号：R739.41[医药卫生—肿瘤]