影响人脑胶质瘤的预后因素

Prognostic factors for patients with glioma

目的研究影响人脑胶质瘤预后的因素,为临床治疗提供理论依据。方法收集自2000年1月至2000年6月在南方医科珠江医院神经外科手术治疗的89例原发性星形细胞肿瘤病人的资料。生存分析单因素使用KaplanMeier法计算生存率并采用对数秩(Logrank)检验;多因素分析使用Cox比例风险模型,采用逐步回归分析。结果单因素分析结果显示年龄、术前机能状况(KPS)评分、术前癫痫、组织学分级、术后放疗等因素与患者预后有关(P<0.01);多因素分析示患者的年龄、术前KPS评分、组织学分级均为独立的预后因素,而术前癫痫、术后放疗则未显示出与预后有关。性别、肿瘤部位、肿瘤范围、手术治疗方式等因素两种分析均未发现与预后有关。结论患者年龄、术前KPS评分、组织学分级对预后影响较大;而术前癫痫史、术后放疗对判断预后价值有限;患者的性别、肿瘤部位和范围、手术治疗方式与预后无关。

Objective To explore the prognostic factors of astrocytic tumors as the theoretical reference to the clinical treatment. Methods Data of 89 patients with astrocytic tumors, admitted in Zhujiang Hospital from January to June 2000, were collected and analyzed with regard to patient age, gender, preoperative KPS score, epilepsy before surgery, histologic grade, tumor location and extension, extent of surgery, radiation, date of operation, date of death, physical state in the last follow-up (dead or alive), and cause of death. For the univariate analysis, survival probabilities were estimated based on Kaplan-Meier's survival analysis and Logrank test. Multivariate regression analysis using Cox's proportional-hazards model showed the simultaneous effect of outcome-related variables on survival. Results Univariate analysis demonstrated that patient age, KPS score, epilepsy before surgery, histologic grade and radiation were the significant factors for survival (P<0.01). In contrast, multivariate survival analysis showed that patient age, histologic grade and KPS score were independent, statistically significant prognostic factors for patients with astrocytic tumors, whereas preoperative epilepsy and postoperative radiation did not reach the significance level for entry into the stepwise model. And gender, tumor location, tumor extension and extent of sugery had no association with patient survival on both univariate and multivariate analysis. Conclusion Patient age, histologic grade and KPS score are associated strongly with survival, while preoperative epilepsy and postoperative radiation appear to be of limited prognostic value. And there is no correlation among gender, extent of surgery and prognosis. Neither tumor location nor tumor extension is associated with survival.