高级别脑胶质瘤术后复发的相关影响因素分析
发布时间：2018-08-18 21:09
【摘要】：目的:探讨影响高级别脑胶质瘤术后复发的相关因素,为临床对脑胶质瘤预后的判断提供帮助,为高级别胶质瘤患者的术后治疗提供更多的理论依据。方法:收集2013年1月至2015年8月在青岛大学附属医院神经外科手术治疗的150例高级别脑胶质瘤患者的临床资料。分别了解患者的性别、年龄、术前KPS评分、术前癫痫发作情况、肿瘤切除范围、肿瘤病理级别、术后放化疗情况、肿瘤分子标志物IDH1的突变状态、Ki-67的表达水平。其中男性82例,女性68例;年龄≤50岁84例,50岁66例;按照WHO分级,Ⅲ级脑胶质瘤84例,Ⅳ级脑胶质瘤66例;术后行化疗者38例,未化疗者112例;术后行放疗者44例,未放疗者106例。肿瘤分子标志物IDH1野生型86例,IDH1突变型64例。采用病历查询及电话随访等方式了解患者的术后情况,患者术后放疗采用三维适形放疗(3D-CRT)或调强放疗(IMRT)技术,术后化疗药物应用替莫唑胺胶囊(TMZ)。随访至患者的疾病复发。术后复发时间定义为首次行胶质瘤切除术至定期影像学复查发现复发病灶的间隔时间。应用SPSS 19.0软件对数据进行统计学分析,以P0.05为统计学判定标准。首先应用t检验了解每项指标的平均复发时间;根据术后复发情况,再应用?2检验进行单因素分析筛选与术后复发相关的因素;最后应用多元Logistic逐步回归分析得出高级别脑胶质瘤患者术后复发的独立影响因素。对患者的年龄、肿瘤病理级别、IDH1突变状态及Ki-67表达水平之间的相关性检验应用Spearman相关性分析。结果:术后复发情况:年龄≤50岁组患者平均复发时间为11.97个月,年龄50岁组患者平均复发时间为7.46个月(P0.05);术前有癫痫发作患者平均复发时间为12.07个月,无癫痫发作患者平均复发时间为9.12个月(P0.05);术后接受放疗患者平均复发时间为13.20个月,未接受放疗患者平均复发时间为8.65个月(P0.05);术后接受化疗患者平均复发时间为14.62个月,未接受化疗患者平均复发时间为8.41个月(P0.05);IDH1突变型患者平均复发时间为13.42个月,IDH1野生型患者平均复发时间为7.42个月(P0.05);Ki-67阳性率≤25%患者平均复发时间为12.13个月,Ki-67阳性率25%患者平均复发时间为8.38个月(P0.05)。单因素分析结果:单因素分析结果显示年龄(P0.05)、术前癫痫发作情况(P0.05)、肿瘤病理级别(P0.05)、术后放疗(P0.05)、术后化疗(P0.05)、肿瘤分子标志物IDH1的突变状态(P0.05)具有统计学意义。多因素分析结果:多元Logistic逐步回归分析结果提示年龄(P0.05)、术后放疗(P0.05)、术后化疗(P0.05)、IDH1突变状态(P0.05)是高级别脑胶质瘤患者术后复发的独立影响因素。相关性分析结果显示:患者的年龄与肿瘤病理级别呈正相关(r=0.2965,P0.05);肿瘤病理级别与Ki-67表达水平呈正相关(r=0.5599,P0.05);IDH1突变状态与Ki-67表达水平呈负相关(r=-0.3932,P0.05)。结论:高级别脑胶质瘤患者年龄50岁、术后未行放化疗、肿瘤分子标志物IDH1野生型是术后复发的独立危险因素,而性别、术前KPS评分、术前癫痫发作情况、肿瘤切除范围、肿瘤病理级别及Ki-67的表达水平对患者术后复发影响不明显。术后行放疗及替莫唑胺辅助化疗可以延缓疾病复发。因此,在今后高级别脑胶质瘤患者的治疗及预后判断方面,需全面了解患者的一般状况,综合考虑各项因素对患者的影响,重点考察患者年龄、术后放化疗情况、肿瘤分子标志物表达情况等,给予最合理最优化的治疗方法与治疗建议,延缓疾病复发改善患者预后。
[Abstract]:Objective: To explore the related factors affecting the recurrence of high-grade gliomas, and to provide more theoretical basis for the prognosis of high-grade gliomas. Methods: 150 cases of high-grade gliomas treated by neurosurgery in the Affiliated Hospital of Qingdao University from January 2013 to August 2015 were collected. The clinical data of patients with glioma were analyzed, including sex, age, preoperative KPS score, preoperative seizures, tumor resection range, tumor pathological grade, postoperative radiotherapy and chemotherapy, mutation of tumor molecular marker IDH1 and expression of Ki-67. WHO grading, grade III glioma 84 cases, grade IV glioma 66 cases; postoperative chemotherapy 38 cases, 112 cases without chemotherapy; postoperative radiotherapy 44 cases, 106 cases without radiotherapy. Tumor molecular marker IDH1 wild type 86 cases, IDH1 mutation 64 cases. Three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT) were performed with temozolomide capsule (TMZ) as the postoperative chemotherapy drug. The patients were followed up until the recurrence of the disease. P 0.05 was used as the statistical criterion. First, t test was used to find out the average recurrence time of each index, then? 2 test was used to screen the factors related to the recurrence after surgery. Finally, multiple logistic stepwise regression analysis was used to determine the independent influencing factors of the recurrence of high-grade glioma patients. Results: The average recurrence time was 11.97 months in patients younger than 50 years old, and 7.46 months in patients aged 50 years old (P 0.05). The average recurrence time was 12.07 months, the average recurrence time was 9.12 months (P 0.05) for patients without epilepsy, 13.20 months for patients receiving radiotherapy after surgery, 8.65 months for patients not receiving radiotherapy (P 0.05), 14.62 months for patients receiving chemotherapy after surgery and 14.62 months for patients not receiving chemotherapy. The average recurrence time was 8.41 months (P 0.05), 13.42 months for IDH1 mutation patients, 7.42 months for IDH1 wild type patients (P 0.05), 12.13 months for Ki-67 positive patients (< 25%) and 8.38 months for Ki-67 positive patients (< 25%). The results showed that age (P 0.05), preoperative seizures (P 0.05), tumor pathological grade (P 0.05), postoperative radiotherapy (P 0.05), postoperative chemotherapy (P 0.05), and mutation status of tumor molecular marker IDH1 (P 0.05) were statistically significant. Postoperative chemotherapy (P 0.05) and IDH1 mutation (P 0.05) were independent risk factors for postoperative recurrence in patients with high-grade gliomas. Conclusion: The age of high-grade glioma patients was 50 years old, and no radiotherapy and chemotherapy were performed. Wild type of tumor marker IDH1 was an independent risk factor for postoperative recurrence. Gender, preoperative KPS score, preoperative seizures, tumor resection range, tumor pathological grade and Ki-67 expression were the independent risk factors for postoperative recurrence. Postoperative radiotherapy and temozolomide adjuvant chemotherapy can delay the recurrence of the disease. Therefore, in the future treatment and prognosis of high-grade glioma patients, it is necessary to fully understand the general situation of patients, comprehensive consideration of the impact of various factors on patients, focusing on the age of patients, postoperative radiotherapy and chemotherapy, tumor score. The expression of sub-markers and so on should be given the most reasonable and optimal treatment methods and treatment recommendations to delay the recurrence of the disease and improve the prognosis of patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41
本文编号：2190684
[Abstract]:Objective: To explore the related factors affecting the recurrence of high-grade gliomas, and to provide more theoretical basis for the prognosis of high-grade gliomas. Methods: 150 cases of high-grade gliomas treated by neurosurgery in the Affiliated Hospital of Qingdao University from January 2013 to August 2015 were collected. The clinical data of patients with glioma were analyzed, including sex, age, preoperative KPS score, preoperative seizures, tumor resection range, tumor pathological grade, postoperative radiotherapy and chemotherapy, mutation of tumor molecular marker IDH1 and expression of Ki-67. WHO grading, grade III glioma 84 cases, grade IV glioma 66 cases; postoperative chemotherapy 38 cases, 112 cases without chemotherapy; postoperative radiotherapy 44 cases, 106 cases without radiotherapy. Tumor molecular marker IDH1 wild type 86 cases, IDH1 mutation 64 cases. Three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT) were performed with temozolomide capsule (TMZ) as the postoperative chemotherapy drug. The patients were followed up until the recurrence of the disease. P 0.05 was used as the statistical criterion. First, t test was used to find out the average recurrence time of each index, then? 2 test was used to screen the factors related to the recurrence after surgery. Finally, multiple logistic stepwise regression analysis was used to determine the independent influencing factors of the recurrence of high-grade glioma patients. Results: The average recurrence time was 11.97 months in patients younger than 50 years old, and 7.46 months in patients aged 50 years old (P 0.05). The average recurrence time was 12.07 months, the average recurrence time was 9.12 months (P 0.05) for patients without epilepsy, 13.20 months for patients receiving radiotherapy after surgery, 8.65 months for patients not receiving radiotherapy (P 0.05), 14.62 months for patients receiving chemotherapy after surgery and 14.62 months for patients not receiving chemotherapy. The average recurrence time was 8.41 months (P 0.05), 13.42 months for IDH1 mutation patients, 7.42 months for IDH1 wild type patients (P 0.05), 12.13 months for Ki-67 positive patients (< 25%) and 8.38 months for Ki-67 positive patients (< 25%). The results showed that age (P 0.05), preoperative seizures (P 0.05), tumor pathological grade (P 0.05), postoperative radiotherapy (P 0.05), postoperative chemotherapy (P 0.05), and mutation status of tumor molecular marker IDH1 (P 0.05) were statistically significant. Postoperative chemotherapy (P 0.05) and IDH1 mutation (P 0.05) were independent risk factors for postoperative recurrence in patients with high-grade gliomas. Conclusion: The age of high-grade glioma patients was 50 years old, and no radiotherapy and chemotherapy were performed. Wild type of tumor marker IDH1 was an independent risk factor for postoperative recurrence. Gender, preoperative KPS score, preoperative seizures, tumor resection range, tumor pathological grade and Ki-67 expression were the independent risk factors for postoperative recurrence. Postoperative radiotherapy and temozolomide adjuvant chemotherapy can delay the recurrence of the disease. Therefore, in the future treatment and prognosis of high-grade glioma patients, it is necessary to fully understand the general situation of patients, comprehensive consideration of the impact of various factors on patients, focusing on the age of patients, postoperative radiotherapy and chemotherapy, tumor score. The expression of sub-markers and so on should be given the most reasonable and optimal treatment methods and treatment recommendations to delay the recurrence of the disease and improve the prognosis of patients.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41
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