神经胶质瘤术后预后的相关因素分析

发布时间：2018-08-19 21:14

【摘要】：研究背景与目的：神经胶质瘤源于神经外胚层的肿瘤，是颅内常见恶性肿瘤，虽然胶质瘤发病率仅在全身肿瘤的2%，但因其生物学行为多呈浸润性生长，由于手术难以彻底切除造成复发率高，术后肿瘤细胞耐药性强，且放疗后可能加重症状，都严重影响患者的术后生存时间与质量，导致患者出现严重的残疾乃至死亡，本研究亦在探讨影响胶质瘤病人术后生存规律、时间的相关因素，了解各因素间有无相应关系，为临床治疗胶质瘤及判断胶质瘤患者预后提供参考。 研究方法：选取2008年1月~2010-12月安徽医科大学第一附属医院神经外科资料齐全的119例神经胶质瘤患者临床资料，搜集患者病例资料。其中包括：性别，男性66例，女性53例；年龄大于50岁70例，小于50岁49例；术前KPS评分大于等于70分63例，小于70分56例；术前存在癫痫患者14例，无癫痫患者104例；术前肿瘤直径大于等于5cm的患者有89例，小于5cm的有30例；手术全切者90例，次全切除29例；将术后病理级别根据WHO分级划分为高级别组（WHO III~IV级，High GradeGlioma）和低级别组（WHO I~II级，Low Grade Glioma, LGG）,HGG83例，LGG36例；肿瘤细胞Ki-67指数＜10%有49例，，Ki-67≥10%有42例；术后进行放疗92例，进行化疗91例。随访已死亡者获完全数据，术后死亡,术后死于非原发病者和失去随访者获取截尾数据。以性别、年龄、术前KPS评分、肿瘤病理分级等10项因素为解释变量，应用COX回归模型进行相关因素的测定，以P0.05为统计学判断标准，计算不同分组患者中位生存月，并对于各项参数应用Kaplan-Meier法绘制生存曲线。结果：应用单因素分析表明，患者发病年龄＜50岁患者（n=70）中位生存时间24个月，较年龄≥50岁（n=49）中位生存期10个月明显延长(P=0.004)；术前KPS评分≥70患者（n=63）中位生存月为26个月，高于术前KPS评分＜70患者（n=56，中位生存月13个月），P=0.001。HGG中位生存期（15个月）较LGG（43个月）明显缩短P=0.001。肿瘤组织Ki-67指数＜10%中位生存期35个月，Ki-67指数≥10%为13个月，P=0.001。术后进行放疗患者较不进行放疗患者中位生存期延长9个月（分别为21个月和12个月,P=0.009）；而COX多因素分析表明，术前KPS评分(P0.01)、肿瘤病理分级(P0.01)、肿瘤组织Ki-67指数(P0.01)及术后是否放疗P0.01)4个因素对于胶质瘤患者预后生存有相关性影响。 结论：年龄≥50岁，高级别胶质瘤、KPS评分70及Ki-67高表达的患者预后较差，术后有效的放化疗显著改善生存期；患者的性别、肿瘤直径大小、手术切除程度、术前有无癫痫对于胶质瘤患者的预后影响不明显。临床治疗中观察以上指标对于胶质瘤的治疗预后的判断具有更强的指导意义
[Abstract]:Background & objective: gliomas originate from neuroectodermal tumors and are common intracranial malignant tumors. Because the recurrence rate is high, the tumor cell resistance is strong, and the symptoms may be aggravated after radiotherapy, the survival time and quality of the patients are seriously affected, resulting in serious disability and even death of the patients. This study was also to explore the relevant factors affecting the survival rule and time of glioma patients, and to find out whether there was a corresponding relationship between these factors, and to provide a reference for clinical treatment of gliomas and prognosis of glioma patients. Methods: 119 patients with glioma were collected from the first affiliated Hospital of Anhui Medical University from January to December, 2008. Including: sex, 66 males, 53 females, 70 cases aged over 50 years, 49 cases younger than 50 years, 63 cases with preoperative KPS score greater than 70 points, 56 cases with less than 70 points, 14 cases with epilepsy before operation, 104 cases without epilepsy. There were 89 cases with tumor diameter greater than or equal to 5cm before operation, 30 cases with less than 5cm, 90 cases with total resection and 29 cases with subtotal resection. According to the WHO grade, the postoperative pathological grades were divided into WHO III~IV high GradeGlioma group and WHO I~II low Grade Glioma, LGG) HGG83 cases, tumor cell Ki-67 index < 10% in 49 cases and Ki-67 鈮

本文编号：2192845