恶性胶质瘤术后放疗的疗效及预后因素分析

Efficacy and the prognostic factors of postoperative radiotherapy in malignant gliomas

目的 探讨恶性胶质瘤手术后放疗的临床疗效及预后影响因素.方法 78例恶性胶质瘤患者行手术后放疗,全脑放疗28例,局部照射34例,三维适形放疗16例.31例行术后化疗,化疗方案主要有司莫司汀、司莫司汀＋替尼泊苷、替莫唑胺等.Kaplan-Meier进行单因素分析,Cox回归多因素分析.结果 全组中位生存时间16个月,1、3、5年生存率分别是65.4%、32.8%、17.9%;Ⅲ级和Ⅳ级胶质瘤中位生存时间24和11个月,1、3、5年生存率分别为72.7%、41.5%、22.8%和47.8%、10.9%、5.4%.单因素分析显示年龄、Karnofsky评分、病理分级、手术切除方式、手术至放疗时间各组间差异有统计学意义（P〈0.05）,多因素分析显示Karmpfsky评分（P=0.000）、病理分级（P=0.004）和年龄（P=0.011）是独立预后因素.结论 Karnofsky评分≥70分、病理分级为Ⅲ级和年龄〈50岁的恶性胶质瘤患者预后较好,手术后放疗联合化疗可提高生存时间.

Objective To explore the clinical effects and prognostic factors of postoperative radiotherapy for malignant gliomas. Methods From June 1998 to October 2007, seventy-eight cases of malignant gliomas patients were treated with radiotherapy after surgery, including -28 cases received whole brain radiotherapy, 34 cases local field irradiation and 16 cases three-dimensional conformal radiotherapy. Thirty-one cases received chemotherapy which included semustine, semustine plus teniposide and temozolomide. Kaplan-Meier survival analysis and COX regression analysis were used to analyze the prognostic factors. Results The median survival time and 1-, 3-, 5-year survival rate were 16 months, 65.4 %, 32.8 % and 17.9 % for all patients, respectively; 24 months, 72.7 %, 41.5 % and 22.8% for grade 1 patients; 11 months, 47.8 %, 10.9 % and 5.4 % for grade IV patients. Univariate analysis showed the age, Karnofsky, pathologic grade, surgical approach and the time from surgery to radiotherapy were significantly correlated with the survival time （P 〈0.05）. Karnofsky （P =0.000）, pathologic grade （P =0.004） and age （P =0.011） were independent prognostic factors in the multivariate analysis. Conclusion Prognosis of the patients with Karnofsky ≥70, age ＆lt; 50 years and grade Ⅲ is better in malignant gliomas. Postoperative radiotherapy combined with chemotherapy may prolong the survival time.