胶质瘤位置特征同患者年龄与预后相关性研究

发布时间：2018-02-04 16:57

  本文关键词： 胶质瘤 肿瘤位置 年龄 体素分析 室管膜下区 低级别胶质瘤 间变胶质瘤 生存　出处：《北京协和医学院》2016年博士论文　论文类型：学位论文

【摘要】：第一部分：胶质瘤分布及同患者年龄关系研究[目的]描述胶质瘤在脑内分布情况,探究肿瘤位置同患者诊断时年龄之间的关系。[方法]我们回顾性入组了200例低级别胶质瘤(LGG)患者和200例多形性胶质母细胞(GBM)患者。通过人工的方法在核磁共振图像上对肿瘤进行图像分割并把相应数据配准到标准脑模板中。得到高、低级别肿瘤在脑内的分布叠加图。然后应用基于体素的回归分析,寻找到同患者诊断时年龄相关的脑区。[结果]肿瘤叠加图显示LGG易累及左侧额叶和双侧颞叶；GBM更易侵袭左侧额叶/颞叶和双侧顶叶。两组肿瘤分布均同室管膜下区(SVZ)关系紧密。肿瘤、年龄分析结果示在LGG组,同患者高龄相关的脑区主要位于右侧额叶中部；而位于左侧颞叶,接近SVZ的脑区同患者低龄相关。在GBM组,同患者高龄相关的脑区主要分布在颞叶,且同SVZ后部相连；位于额叶下部的脑区同患者低龄相关。两组肿瘤中,分别位于以上区域内的患者同肿瘤分布在其他区域的患者相比年龄具有显著差异。[结论]本研究通过定量的方法描述了胶质瘤的分布特点。并寻找到同患者年龄相关的脑区,提示高龄、低龄患者发生肿瘤具有位置特异性。第二部分：胶质瘤累及室管膜下区同患者预后关系研究[目的]室管膜下区(Svz)为成人神经干细胞的主要存在区域,该区域同胶质瘤的发生、发展和生物学行为存在紧密的联系。肿瘤累及SVZ在多形性胶质母细胞瘤中被认为是预后不佳的因素。本研究以较低级别胶质瘤为研究对象,评价肿瘤累及SVZ对该部分患者预后的影响。[方法]本课题研究分别入组了143例弥漫性星形细胞瘤和160例间变胶质瘤患者。通过核磁图像对肿瘤和SVZ进行图像分割,应用定性、定量的方法对肿瘤和SVZ关系进行分析。[结果]在弥漫性星形细胞瘤组中,肿瘤累及SVZ为患者总生存期(OS)的显著预后因素(p=0.027)。在肿瘤累及SVZ的亚组中,单因素生存分析提示肿瘤质心距离SVZ更近时(≤30mm)患者OS更短(p=0.022)。但肿瘤累及SVZ不同亚区对患者生存无显著影响(p=0.930)。多因素生存分析结果示在肿瘤累及SVZ的患者中,肿瘤质心距离SVZ越近(p=0.039)患者OS越短。在间变胶质瘤组中,单因素生存分析提示肿瘤累及SVZ同患者无进展生存期(PFS)p=0.021)和OS(p0.001)显著相关。多因素生存分析显示肿瘤累及SVZ为预后不佳的独立预测因素(p=0.016,OS),而且累及SVZ枕角的患者预后更差(p0.001,PFS；p=0.016,OS).[结论]本研究提示在较低级别胶质瘤中累及SVZ患者预后不佳,为基础研究和临床应用提供了基础。
[Abstract]:The first part: the distribution of glioma and its relationship with patient's age. [Objective] to describe the distribution of gliomas in the brain and to explore the relationship between tumor location and age at the time of diagnosis. [Methods: we retrospectively reviewed 200 patients with low grade glioma (LGG) and 200 patients with glioblastoma pleomorphic (GBM). Patient. The tumor image was segmented on MRI image by artificial method and the corresponding data was registered to the standard brain template. The distribution of low-grade tumors in the brain was superposed, and then the age related brain regions were found by using voxel based regression analysis. [Results] tumor superposition images showed that LGG easily involved the left frontal lobe and bilateral temporal lobe. GBM was more likely to invade the left frontal / temporal lobe and bilateral parietal lobe. The distribution of tumors in both groups was closely related to the subependymal area. The age analysis showed that the tumor was found in the LGG group. The brain regions associated with the patient's old age were mainly located in the middle of the right frontal lobe. In the GBM group, the brain regions related to the elderly patients were mainly located in the temporal lobe and connected with the posterior part of SVZ. The brain area located in the lower part of the frontal lobe was associated with the younger age of the patients. In the two groups of tumors, the patients located in the above regions were significantly different in age compared with those in the other regions of the tumors. [Conclusion] in this study, the distribution of gliomas was described by quantitative method, and the brain regions related to the patients' age were found. Tumorigenesis in young patients is location-specific. Part two: relationship between subependymal area involvement and prognosis of patients with gliomas. [Objective] the subependymal area (Svz) is the main region of adult neural stem cells (NSCs), which is associated with the occurrence of glioma. There is a close relationship between development and biological behavior. Tumor involvement of SVZ in glioblastoma pleomorphic is considered to be a factor of poor prognosis. To evaluate the effect of tumor involvement with SVZ on the prognosis of these patients. [Methods: in this study, 143 patients with diffuse astrocytoma and 160 patients with anaplastic glioma were studied. The images of tumor and SVZ were segmented by nuclear magnetic imaging and qualitative analysis was used. The relationship between tumor and SVZ was analyzed by quantitative method. [Results] in diffuse astrocytoma group, SVZ involvement was a significant prognostic factor for the total survival time of patients with astrocytoma. Univariate survival analysis showed that patients with tumor centroid closer to SVZ (鈮，

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