化疗时机、年龄等因素对新诊断高级别脑胶质瘤患者预后的影响

发布时间：2018-03-11 06:34

本文选题：胶质母细胞瘤　切入点：生存预后　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的胶质母细胞瘤（Glioblastoma multiforme, GBM）是最常见的成人原发性恶性脑肿瘤。目前针对新诊断GBM患者的标准治疗方案包括最大范围安全切除肿瘤，术后辅以替莫唑胺（Temozolomide, TMZ）同步放疗联合TMZ辅助化疗。然而，新诊断GBM患者能否从术后早期TMZ化疗中获益目前不清，故本研究回顾性分析一组术后2周内TMZ化疗的患者，以期望初步获得TMZ化疗时机对患者的生存预后的影响。方法回顾性分析一组收集自2007年03月至2012年12月在福建医科大学附属第一医院神经外科手术治疗且经术后病理证实的75例新诊断GBM患者的临床资料，进行生存随访，评估术后2周内早期TMZ化疗是否对新诊断GBM患者术后的生存产生影响。单因素采用Kaplan-Meier法，多因素使用Cox比例风险模型分析。结果单因素分析结果显示年龄（P=0.005）、化疗周期（P=0.001）、化疗时间（P=0.004）、放疗（P=0.023）及术前KPS评分（P=0.004）均与患者总生存时间有关系。年龄≤50岁的中位总生存时间为20.0月（95%CI10.900-29.100），，长于年龄＞50岁的11.0月（95%CI9.188-12.812），结果有差异（P=0.005）；术后2周内予以TMZ化疗的中位总生存时间为16.0月（95%CI11.167-20.833），长于术后2周后TMZ化疗的12.0月（95%CI9.557-14.433）及无化疗的的7.0月（95%CI5.936-8.064)（P=0.004）；术后规则化疗的中位总生存时间为20.0月（95%CI13.351-26.649），长于不规则化疗的10.0月（95%CI7.009-12.991）以及无化疗的7.0月（95%CI5.936-8.064)（P=0.001）；术后放疗的中位总生存时间为18.0月（95%CI13.414-22.586），长于未放疗的9.0月（95%CI6.739-11.261）（P=0.023）；术前KPS≥80分的中位总生存时间为13.0月（95%CI5.008-20.992），长于KPS＜80分的9.0月（95%CI5.425-12.575）（P=0.004）。而多因素分析结果则显示年龄（P=0.029）、化疗周期（P=0.001）及术前KPS评分（P=0.006）为影响肿瘤总生存时间的独立因素。结论术后早期予以TMZ化疗可以使患者受益。此外，年龄、化疗周期及患者术前KPS评分也是影响新诊断GBM患者预后的独立因素。目的年龄对脑胶质瘤预后的影响一直为人们所重视，但是年龄是否为预后的独立影响因素目前仍有争议，而且不同的报告中患者的年龄段的划分标准也不尽相同，在预后判断中哪种年龄段划分标准最为合适目前未见报告，故本研究旨在探讨高级别大脑半球胶质瘤患者的不同年龄段划分标准对预后判断的的影响。方法收集自2002年6月至2012年6月在福建医科大学附属第一医院神经外科手术治疗的125例且经术后病理证实的高级别大脑半球胶质瘤患者的临床资料。分别以≤50岁和＞50岁，≤60岁和＞60岁，≤45岁、45-65岁和≥65岁等三种年龄段的不同划分，评估其对高级别脑胶质瘤患者预后的影响。单因素采用Kaplan-Meier法、多因素使用Cox比例风险模型分析。结果单因素分析结果显示三种不同的年龄段划分标准≤45岁、45-65岁和≥65岁（P=0.001），≤50岁和＞50岁（P＜0.0001）、≤60岁和＞60岁（P＜0.0001）、病理级别（P＜0.0001）均与患者总生存时间有关系；女性的中位总生存时间为28.0月（95%CI5.407-50.593），长于男性的15.0月（95%CI9.771-20.229），结果有差异（P=0.030），术后规则化疗的中位总生存时间为28.0月（95%CI1.134-54.866），长于未化疗的11.0月（95%CI7.553-14.447）以及不规则化疗的21.0月（95%CI10.175-31.825）（P=0.001）；术后放疗的中位总生存时间为28.0月（95%CI15.104-40.896），长于未放疗的11.0月（95%CI8.491-13.509）（P＜0.0001）。而多因素分析结果则显示只有≤50岁和＞50岁的年龄段划分标准（P＜0.0001）、病理级别（P＜0.0001）、化疗（P=0.001）为影响肿瘤总生存时间的独立因素。结论作为高级别大脑半球胶质瘤患者独立预后判断的合适年龄段划分标准为≤50岁和＞50岁。此外，病理级别、化疗也是影响高级别大脑半球脑胶质瘤术后总生存期的独立因素。
[Abstract]:objective
Glioblastoma (Glioblastoma multiforme GBM) is the most common adult primary malignant brain tumors. For the patients with newly diagnosed GBM standard treatment including the maximum safe removal of the tumor, postoperative adjuvant temozolomide (Temozolomide, TMZ) radiotherapy combined with TMZ chemotherapy. However, new diagnosis of GBM patients can benefit from early TMZ was unclear after chemotherapy in this study were retrospectively analyzed in 2 weeks of TMZ chemotherapy group after operation, in order to obtain preliminary effect of TMZ chemotherapy on the survival time of the patients.
Method
A retrospective analysis of a group were collected from 2007 03 to December 2012 in the First Affiliated Hospital of Fujian Medical University, Department of Neurosurgery surgery and confirmed by surgery and pathology in 75 cases of newly diagnosed GBM patients with clinical data, survival follow-up assessment within 2 weeks after surgery for early TMZ chemotherapy in patients with newly diagnosed GBM postoperative survival impact. Using Kaplan-Meier analysis method, Cox proportional hazard model using multiple factors.
Result
Univariate analysis showed that age (P=0.005), cycles of chemotherapy (P=0.001), time of chemotherapy (P=0.004), radiotherapy (P=0.023) and preoperative KPS score (P=0.004) were associated with the survival time of patients aged less than 50 years. The median overall survival time was 20 months (95% CI10.900-29.100), longer than the age. The 50 year old 11 months (95%CI9.188-12.812), the difference (P=0.005); the median overall survival time to TMZ chemotherapy within 2 weeks after surgery was 16 months (95%CI11.167-20.833), 12 months after 2 weeks longer than TMZ chemotherapy after operation (95%CI9.557-14.433) and chemotherapy 7 months (95%CI5.936-8.064) (P=0.004) postoperative regular chemotherapy; the median survival time was 20 months (95%CI13.351-26.649), longer than the irregular chemotherapy 10 months (95%CI7.009-12.991) and 7 months without chemotherapy (95%CI5.936-8.064) (P=0.001); postoperative radiotherapy median overall survival time was 18 months (95%CI13.414-22.586) No longer than 9 months, radiotherapy (95%CI6.739-11.261) (P=0.023); preoperative median overall survival time of KPS is more than or equal to 80 points for 13 months (95%CI5.008-20.992), KPS < 80 minutes longer than 9 months (95%CI5.425-12.575) (P=0.004). The results of multivariate analysis showed age (P=0.029), cycles of chemotherapy (P=0.001) and preoperative KPS score (P=0.006) were independent factors affecting the survival time of the tumor.
conclusion
Early TMZ chemotherapy can benefit patients. In addition, age, chemotherapy cycle and preoperative KPS score are also independent prognostic factors for newly diagnosed GBM patients.
objective
Effect of age on the prognosis of glioma has been paid attention to by people, but if the age was an independent prognostic factor remains controversial, and the division standard of different age patients in the report are not the same, the prognosis of which age division standard is most appropriate at present there is no report, so that the influence of the purpose of this study is to investigate the different age criteria for the classification of high grade cerebral glioma patients on prognosis.
Method
Collected from June 2002 to June 2012 in the clinical data of 125 cases of the First Affiliated Hospital of Fujian Medical University, Department of Neurosurgery, surgery and pathologically confirmed high-grade cerebral glioma patients. In less than 50 years and more than 50, less than 60 years and more than 60, less than 45 years, divided into different 45-65 years old and above 65 years three age, assess its impact on the prognosis of patients with high-grade gliomas. Single factor analysis using Kaplan-Meier method and Cox proportional hazard model using multiple factors.
Result
The results of univariate analysis showed that three ages of less than or equal to 45 different standards, 45-65 years old and above 65 years (P=0.001), less than 50 years old and over 50 years (P < 0.0001), less than 60 years old and over 60 years (P < 0.0001), pathological grade (P < 0.0001) have a relationship with overall survival time; the median survival time of female was 28 months (95%CI5.407-50.593), 15 months longer than the male (95%CI9.771-20.229), the difference (P=0.030), postoperative regular chemotherapy median overall survival time was 28 months (95%CI1.134-54.866), longer than 11 months without chemotherapy (95%, CI7.553-14.447) 21 month irregular chemotherapy (95%CI10.175-31.825) (P=0.001); postoperative radiotherapy median overall survival time was 28 months (95%CI15.104-40.896), longer than 11 months without radiotherapy (95%CI8.491-13.509) (P < 0.0001). Multivariate analysis showed that only less than 50 years of age, and 50 year old standards (P < 0 01), pathological grade (P < 0.0001), chemotherapy (P=0.001) was an independent factor affecting the total survival time of the tumor.
conclusion
As an independent prognostic judgment high grade cerebral glioma patients age appropriate criteria for less than 50 years and over 50 years. In addition, pathological grades, chemotherapy also affect the high level brain glioma patients after independent factors for overall survival.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

【共引文献】