幕上大脑半球高级别星形细胞瘤预后的影响因素分析

Analysis of various clinical prognostic factors in patients with supratentorial high-grade astrocytoma

目的探讨与幕上大脑半球高级别星形细胞瘤生存预后相关的临床因素。方法回顾接受手术与术后辅助性放疗及化疗的97例高级别星形细胞瘤的临床资料,其中间变性星形细胞瘤(AA)60例,胶质母细胞瘤(GB)37例。随访其生存状况,用Kaplan-Meier单因素生存分析与COX多元回归分析作统计学处理。结果间变性星形细胞瘤和胶质母细胞瘤的无进展生存时间(PFS)分别为18和10个月,两者总生存时间(OS)分别为21和12个月;年龄“≤40岁”与“>40岁”者PFS各为18和10个月,OS各为21和13个月;治疗前“KPS≥80”与“<80”PFS各为15和10个月,OS为18和12个月;术前有抽搐症状与否的PFS各为21和11个月,OS为24和14个月;术前MR检查肿瘤强化与否的PFS各为11和18个月,OS为14和21个月。单因素分析显示,上述各因素与病人PFS和OS相关(P<0.05)。性别、肿瘤直径、肿瘤部位、肿瘤切除程度与病人PFS、OS关系无统计学意义(P>0.05)。COX回归分析显示年龄大小、肿瘤级别的高低、治疗前KPS评分、术前有无抽搐症状是影响预后的显著因素。结论年龄较小、高KPS评分、低病理级别及术前有抽搐症状被提示是高级别星形细胞瘤患者获得较长生存期的保护因素,而性别、肿瘤部位、肿瘤大小和手术切除程度对预后影响无统计学意义。肿瘤强化与预后的关系有待进一步研究证实。

Objective To investigate the influence of various clinical prognostic factors in patients with supratentorial high-grade astrocytoma （HGA）. Methods A total of 97 patients with HGA were treated with surgery and postoperative radiation therapy and adjuvant chemotherapy. There were 60 anaplastic astrocytoma（AA） ,and 37 glioblastoma （GB）. Their survival status was followed -up. Survival related statistics were calculated using the Kaplan-Meier method, and differences between survival curves were analyzed by the log-rank test. The interaction of each prognostic factor and their effect on overall survival（OS） and progression-free survival（PFS） were analyzed with the Cox proportional hazards model. Results The median PFS and OS for all 97 patients were 13, and 15 months, respectively. When PFS and OS were used as endpoints, AA lived longer than GB, while patients 40 years old or less lived longer than those more than 40 years old. Patients with Karnofsky performance status （KPS） 80 to 100 had longer survival than those with KPS 60 to 70 as well as did patients with preoperative seizure when compared to those without. Both univariate and multivariate Cox analyses confirmed independent influence of these factors, whereas, gender, tumor size, tumor location, and extent of surgery were not of prognostic significance . Noncontrast -enhancing tumor was statistically significant prognostic indicators in univariate analysis, but it was not of statistical significance in multivariate Cox analysis. Conclusions This study showed that younger, higher KPS, lower grade of pathology, and preoperative seizure were protective prognostic factors in patients with HGA, while gender, tumor size, tumor location, and extent of surgery had no prognostic significance. The prognostic significance of contrast -enhancing was uncertain.