高级别胶质瘤的预后影响因素分析.

Objective To investigate the factors affecting the prognosis of patients with high-grade glioma. MethodsThe data of 384 cases of high-grade gliomas surgically removed in the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2015 were analyzed retrospectively to exclude non-surgical deaths. The survival analysis was performed by using Kaplan-Meierand the Cox proportional hazard regression model was used for prognostic multivariate analysis. ResultsThere were 384 high-grade gliomas in this group, including 164 cases of WHO Ⅲ grade and 220 cases of WHO Ⅳ grade. All of them received surgery from the same group of doctors. Postoperative radiotherapy and chemotherapy were performed in 212 patients and 243 patients. At 1 and 3 years follow-up, the overall survival rates were 73.7% and 17.1%, respectively. The WHO Ⅲ grade 1 and 3 year survival rates were 92.3% and 29.5%, respectively. The WHO Ⅳ grade 1 and 3 years survival rates were 60.2% and 11.7%, respectively. Multivariate analysis showed that postoperative adjuvant radiotherapy and chemotherapy significantly improved the survival rate of high-grade glioma(P＜0.05). Cox proportional hazard regression model analysis showed age＞60 years(RR=1.701，P=0.016), preoperative KPS score ＜70 points (RR=2.231，P＜0.001), WHO Ⅳ grade(RR=2.181，P＜0.001) tumors were not completely resected(RR=2.101,P＜0.001), and no postoperative radiochemotherapy(RR=1.562,P=0.007) was an independent risk factor for the overall survival of high-grade gliomas. There was no significant difference in gender, tumor size, necrosis/capsule change, and total stage(all P＞0.05). Patients with age ＜60 years, preoperative KPS score ≥70, WHO Ⅲ grade glioma, total tumor resection, and postoperative combined chemoradiotherapy had longer overall survival（OS）. ConclusionThe age of onset ＜60 years old, KPS score≥70, low WHO grade(Ⅲ), total tumor resection, postoperative radiotherapy and chemotherapy of glioma patients with good prognosis, combined with radiotherapy and chemotherapy can improve the efficacy of glioma. [ABSTRACT FROM AUTHOR]

目的探讨影响高级别胶质瘤预后的相关因素。方法对新疆医科大学第一附属医院神经外科中心2013年1月-2015年12月，行手术切除的384例高级别胶质瘤患者的临床资料进行回顾性分析。排除非手术因素死亡，采用Kaplan-Meier法进行生存率分析，以及Cox比例风险回归模型进行预后多因素分析。结果本组患者中，WHO Ⅲ级164例，WHO Ⅳ级220例，均接受同组医生手术。术后接受放疗、化疗者分别为212例和243例。随访1年、3年的总体生存率分别为73.7%、17.1%；WHO Ⅲ级患者的1年、3年生存率分别为92.3%、29.5%，WHO Ⅳ级患者的1年、3年生存率分别为60.2%、11.7%。多因素分析显示术后辅助放疗、化疗显著提高高级别胶质瘤患者的生存率（P＜0.05）。Cox比例风险回归模型分析显示，年龄＞60岁（RR=1.701；P=0.016）、术前KPS评分＜70分（RR=2.231；P＜0.001）、WHO Ⅳ级(RR=2.181；P＜0.001）、肿瘤未全切(RR=2.101；P＜0.001）、术后未联合放化疗（RR=1.562；P=0.007），是影响高级别胶质瘤总体生存率的独立危险因素。而性别、肿瘤大小、有无坏死/囊变，总生存期差异均无统计学意义(均P＞0.05)。年龄＜60岁、术前KPS评分≥70分、WHO Ⅲ级胶质瘤、肿瘤全切、术后联合放化疗患者的总生存期较长。结论发病年龄＜60岁、KPS≥70分、WHO级别低(Ⅲ级)、肿瘤全切、术后放化疗的高级别胶质瘤患者的预后较好；术后联合进行放化疗可以提高胶质瘤的疗效。 [ABSTRACT FROM AUTHOR]