恶性脑胶质瘤术后放化疗疗效及预后因素分析

发布时间：2018-05-29 01:42

  本文选题：恶性胶质瘤 + 放射治疗　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:分析恶性脑胶质瘤术后放化疗的临床疗效以及相关预后因素,为恶性胶质瘤患者治疗方案的选择和预后评价提供依据。方法:回顾性分析大连医科大学附属第一医院放疗科自2010年1月至2015年9月间收治并且资料齐全的80例(共84例,失访4例)初发恶性脑胶质瘤患者资料,其中单独行放疗者(单放组)34例,放疗联合化疗者(放化组)46例,男性患者48人,女性患者32人,病理分级Ⅲ级者33人,Ⅳ级者47人。所有患者均行颅内肿瘤完全或大部切除术。于术后4周左右始行三维适形放射治疗(3DCRT)或调强放射治疗(IMRT),6MV X线外照射,95%PTV150Gy/2Gy/25F;95%PTV2 10Gy/2Gy/5F。总剂量 60Gy,6 周完成。放化组患者化疗方案均为口服替莫唑胺胶囊(TMZ),与放疗同步、序贯或同步+序贯使用。同步放疗期间为75mg/m2/日,每日服用(放疗间歇不中断)。序贯化疗开始于放疗结束4周后,口服剂量为200mg/m2/日,连服5天,停药23天,28天为一个周期,共6个周期。应用SPSS 24.0软件进行统计学分析,统计所有患者中位生存时间及1、2年生存率,比较单纯放疗和放疗联合TMZ化疗两组患者的疗效差异,及放疗期间两组患者不良反应的发生情况。采用Kaplan-Meier法进行生存分析,分析可能影响恶性脑胶质瘤预后的相关因素,并建立Cox风险回归模型进行多因素分析,得出独立的预后影响因素(p0.05为差异有统计学意义)。结果:(1)至随访结束,全组80例患者,死亡53例,尚存活27例,中位生存时间为23.9个月,1、2年总生存率分别为83.8%、46.3%。全组患者整体分析中,单放组与放化组相比,两组中位生存时间分别是21.9个月和27.5个月(p=0.702),差异无统计学意义。(2)进一步亚组分析,Ⅳ级患者中,单放组和放化组患者中位生存时间分别为11.6个月和23.9个月(p=0.018),差异有统计学意义;Ⅲ级患者中,单放组和放化组患者中位生存时间分别为56.7个月和40.4个月(p=0.707),差异无统计学意义。(3)全组患者放疗期间出现的不良反应主要表现为血小板减少、白细胞总数下降、胃肠道反应和周身乏力,放疗同期联合TMZ化疗与单纯放疗组相比,不良反应发生率无明显差异(p值分别为1.000、0.474、0.447、0.780)。(4)单因素分析:以下因素经log-rank检验,年龄≥60岁与60岁(14.9 vs.38.7个月,p0.001)、病理分级 Ⅲ 级与 Ⅳ 级(56.7 vs.18.5 个月,p0.001)、术前是否有重度瘤周水肿(20.9vs.49.6个月,p=0.025)、术前KPS评分≥70分与70 分(35.6vs.18.5 个月,p=0.004)、切除程度(27.5vs.20.9 个月,p=0.017)、肿瘤部位(49.6 vs.23.6 个月,p=0.026)、病灶个数(27.5 vs.16.7 个月,p=0.042),其中位生存时间差异有统计学意义。而性别(p=0.937)、术前有无神经症状(p=0.682)、肿瘤最大径(p=0.349)、有无TMZ化疗(p=0.702)、手术与放疗时间间隔(p=0.965)、放疗方式(p=0.412),其中位生存时间差异无统计学意义。(5)多因素分析:建立COX风险回归模型,病理分级(p=0.027)、年龄(p=0.029)和术前KPS评分(p=0.044),是恶性脑胶质瘤独立的预后影响因素。结论:(1)放疗联合TMZ化疗与单纯放疗相比,可使Ⅳ级脑胶质瘤患者中位生存期显著延长,但对Ⅲ级患者中位生存期的影响不明显。(2)放疗同期联合TMZ化疗与单独放疗相比未增加患者不良反应发生率。(3)年龄、病理分级、是否有重度瘤周水肿、术前KPS评分、切除程度、肿瘤部位、病灶个数,以上7个因素是影响恶性脑胶质瘤患者中位生存时间的显著因素,年龄60岁、病理分级Ⅲ级、无重度瘤周水肿、术前KPS评分≥70分、肿瘤全切、肿瘤位于额叶、病灶单发者中位生存时间较长,预后较好;(4)年龄、病理分级、术前KPS评分是恶性脑胶质瘤预后的独立影响因素。
[Abstract]:Objective: to analyze the clinical efficacy and prognostic factors of postoperative radiotherapy and chemotherapy for malignant glioma, and to provide basis for the selection and prognosis evaluation of the patients with malignant glioma. Methods: a retrospective analysis of 80 cases (84 cases) from January 2010 to September 2015, the First Affiliated Hospital of Dalian Medical University, which were admitted from January 2010 to September 2015. 4 cases of primary malignant glioma were reported, including 34 cases of single radiotherapy (single radiotherapy), 46 cases of radiotherapy combined with chemotherapy (chemoradiotherapy group), 48 male patients, 32 female patients, 33 histopathological grade III and 47 of grade IV. All patients underwent complete or large resection of intracranial swelling tumor. Three dimensional conform began about 4 weeks after the operation. Radiation therapy (3DCRT) or intensity modulated radiation therapy (IMRT), 6MV X-ray external irradiation, 95%PTV150Gy/2Gy/25F; 95%PTV2 10Gy/2Gy/5F. total dose 60Gy, 6 weeks complete. The chemotherapy regimen of the chemoradiation group were all oral Temozolomide Capsules (TMZ), synchronized with radiotherapy, sequential or simultaneous + sequential use. Sequential chemotherapy started at 4 weeks after the end of radiotherapy. The oral dose was 200mg/m2/ days, even 5 days, 23 days and 28 days as a cycle, with a total of 6 cycles. Statistical analysis was carried out with SPSS 24 software. The median survival time and 1,2 survival rate of all patients were statistically compared with those of two groups of patients with the combination of radiotherapy and radiotherapy combined with radiotherapy combined with TMZ chemotherapy. Differences, and the occurrence of adverse reactions in the two groups of patients during the radiotherapy. The survival analysis was carried out by the Kaplan-Meier method, the factors that might affect the prognosis of malignant glioma were analyzed, and the Cox risk regression model was established for multiple factors analysis to obtain the independent prognostic factors (P0.05 was statistically significant). Results: (1) to follow-up At the end, there were 80 patients in the whole group, 53 cases of death and 27 cases of survival, the median survival time was 23.9 months and the total survival rate of 1,2 years was 83.8%. In the whole group analysis of 46.3%. group, the median survival time of the two groups was 21.9 months and 27.5 months respectively (P =0.702), respectively. (2) further subgroup analysis, IV Among the patients, the median survival time was 11.6 months and 23.9 months (p=0.018), respectively. The median survival time was 56.7 months and 40.4 months (p=0.707), respectively. (3) the adverse reaction occurred during the whole group. The main manifestations were thrombocytopenia, leukocyte count decline, gastrointestinal reaction and body fatigue. The incidence of adverse reactions was not significantly different (P value 1.000,0.474,0.447,0.780, respectively) compared with the radiotherapy group (1.000,0.474,0.447,0.780). (4) single factor analysis: log-rank test with lower factors, age above 60 years and 60 years (14.9 vs.38.7) A month, p0.001), pathological grade III and IV (56.7 vs.18.5 months, p0.001), had severe peritumoral edema (20.9vs.49.6 months, p=0.025) before operation, before operation, KPS score was more than 70 points and 70 (35.6vs.18.5 months, p=0.004), the degree of resection (27.5vs.20.9 months, p=0.017), tumor site (49.6 vs.23.6 month, p=0.026), and the number of lesions (27.5) S.16.7 months, p=0.042), the survival time difference was statistically significant. And sex (p=0.937), there were no neurologic symptoms (p=0.682), tumor maximum diameter (p=0.349), TMZ chemotherapy (p=0.702), operation and radiotherapy interval (p=0.965), radiotherapy formula (p=0.412), and there was no statistical significance for the difference of survival time. (5) multivariate analysis: Construction COX risk regression model, pathological grading (p=0.027), age (p=0.029) and preoperative KPS score (p=0.044) are independent prognostic factors of malignant glioma. Conclusion: (1) radiotherapy combined with TMZ chemotherapy and radiotherapy alone can significantly prolong the median survival of patients with grade IV glioma, but the impact on the median survival of grade III patients is unclear. (2) (2) the incidence of adverse reactions was not increased by combined radiotherapy combined with radiotherapy alone. (3) age, pathological grading, severe peritumoral edema, preoperative KPS score, resection degree, tumor location, number of lesions, and the above 7 factors are significant factors affecting the median survival time of patients with malignant glioma, age 60, pathology Grade III, no severe peritumoral edema, preoperative KPS score was more than 70 points, tumor was completely cut, tumor was located in frontal lobe, the median survival time was longer and prognosis was better, and (4) age, pathological grading, and preoperative KPS score were independent factors of prognosis of malignant glioma.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41
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本文编号：1949009