92例高级别胶质瘤患者术后生存分析

Postoperative survival of high-grade glioma: An analysis of 92 cases

摘要:

目的 探讨影响高级别胶质瘤术后生存的因素。方法 对2014年1月至2016年8月首诊确定为高级别胶质瘤（WHO Ⅲ-IV级）的92例患者采用Kaplan-Meier法分析生存率，Log-rank检验进行单因素分析，Cox回归模型进行多因素分析。结果 中位生存期为15个月，中位无进展生存期为8个月，肿瘤全切率为72.83%，1年、2年、3年、4年的生存率分别为56.5%，35.9%，30.4%，25.4%。Log-rank单因素分析表明高级别胶质瘤预后与年龄、术前生活质量评分、肿瘤大小、数目、是否累及多个皮层脑叶或者运动功能区、切除程度、病理级别、异柠檬酸脱氢酶基因是否突变、O-6-甲基鸟嘌呤DNA甲基转移酶基因启动子是否甲基化、Ki 67指数、术后是否进行放疗和/或化疗以及所进行的放化疗的方式、复发后是否积极治疗相关（P<0.05）。引入检验水准（α=0.01），COX多因素分析表明年龄、肿瘤切除程度、术后是否进行放疗和/或化疗是影响高级别胶质瘤预后的独立危险因素（P<0.01）。结论 发病年龄<65岁、肿瘤全切除、术后进行同步放化疗和辅助化疗的高级别胶质瘤患者预后较好。

Abstract:

Objective To investigate the influencing factors for the postoperative survival of high-grade glioma.Methods A total of 92 patients who were diagnosed with high-grade glioma (WHO grade Ⅲ-IV) at initial diagnosis from January 2014 to August 2016 were enrolled. The Kaplan-Meier method was used to evaluate survival rate, the log-rank test was used for univiriate analysis, and the Cox regression model was used for multivariate analysis.Results The median survival time was 15 months, and the median progress-free survival was 8 months. The overall tumor resection rate was 72.83%, and the 1-, 2-, 3-, and 4-year survival rates were 56.5%, 35.9%, 30.4%, and 25.4%, respectively. The log-rank univariate analysis showed that the prognosis of high-grade glioma was associated with age, preoperative Karnofsky Performance Scale score, size/number/location of tumors, whether multiple cerebral lobes or motor function regions were involved, extent of resection, pathological grade, presence or absence of isocitric dehydrogenase gene mutation, presence or absence of methylation of O-6-methylguanine-DNA methyltransferase gene promoter, Ki 67 index, whether radiotherapy and/or chemotherapy were performed after surgery and the mode of radiochemotherapy, and whether active treatment was given after recurrence (P<0.05). With a significance level of α=0.01, the Cox multivariate analysis showed that age, extent of resection, and whether radiotherapy and/or chemotherapy were performed after surgery were independent risk factors for the prognosis of high-grade glioma (P<0.01).Conclusions Patients with high-grade glioma with an age of onset of <65 years, total tumor resection, and concurrent chemoradiotherapy and adjuvant chemotherapy after surgery tend to have good prognosis.