胶质瘤术后预后因素的分析

Analysis of prognostic factors for postoperative patients with glioma

目的:探讨胶质瘤治疗和影响预后的因素。方法:回顾性的分析547例胶质瘤手术病人,对预后进行单因素及多因素分析。结果:本组病人5年生存率44.6%,Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级胶质瘤的5年生存率依次为86.8%、54.8%、21.8%和11.4%,Ⅰ级和Ⅱ级,Ⅰ级和Ⅲ级,Ⅰ级和Ⅳ级,Ⅱ级和Ⅲ级,Ⅱ级和Ⅳ级之间差别均有统计学意义(p≤0.05),肿瘤全切与未全切的5年生存率各为55.2%和25.3%(p<0.05),术前KPS评分≥80与<80的5年生存率各为51.8%和26.5%(p<0.05),年龄≤40岁与>40岁的5年生存率各为54.8%和28.6%(p<0.05)。COX模型的多因素分析结果显示:低级别肿瘤、肿瘤全切、年龄较小、术前KPS评分≥80是预后较好的有利因素,而性别、肿瘤位置、肿瘤直径、有无囊变、手术至放疗时间对预后影响不明显,有无辅助化疗对高级别肿瘤无明显改善。结论:年龄大小、术前KPS评分、肿瘤切除程度、肿瘤级别的高低是影响预后的显著因素。

Objective： To analyse the influence factors of prognosis of patients with glioma and to explore a better therapy. Methods： 547 glioma patient, who received operation in our department 5 years ago, were retrospectively analysed and their data were investigated with logsitic regression analysis model. Results： The survival rate of 5 years for the group was 44.6 %, and that of the first, the second, the third and the fourth grade ofglioma was 86.8 %, 54.8 %, 21.8 % and 11.4 % in turn. There were significant statistical differences between the first and the second, the first and the third, the first and the fourth, the second and the third, the second and the fourth grade of glioma （p ≤ 0.05 ）. The 5-year-survival rate was 55.2 % in the group with complete resection of glioma and 25.3 % in the group with partial resection ofglioma （p〈0.05）. The 5-year-survival rate was 51.8 % in the group of KPS score （〉80） and 26.5 %in the group of KPS score （ 〈80 ） （p〈0.05）. The 5-year-survival rate was 54.8 % （ age ≤ 40 ） and 28.6 % （age〉40） （ p〈0.05 ）. Cox regression analysis revealed that low grade of glioma, complete resection of glioma, patients aged less than 40 years, and KPS score more than 80 were favourable factors of prognosis; while patients＇ gender, tumor location and diameter, with or without cystoid degeneration, early or late postoperative radiotherapy don＇t influence greatly on prognosis . Adjuvant chemotherapy is not associated with high grade of glioma Conclusion： Age, KPS score, extent of resection, pathologic grade were significant influence factors for prognosis.