手术联合^(125)I粒子植入治疗复发性脑胶质瘤及预后因素初步分析

Outcomes and prognostic factors of microsurgical excision combined with 125I seeds implants in patients with recurrent malignant glioma

目的探讨手术联合125I粒子植入治疗复发性脑胶质瘤的疗效及影响预后的主要因素。方法 60例手术加放化疗后复发的脑胶质瘤患者随机分为手术联合125I粒子植入组35例,单纯手术对照组25例进行治疗,术后每2个月复查MRI进行随访,收集临床资料和随访结果进行分析。用Kaplan-Meier法计算全组的累积生存率,Log-Rank检验做单因素分析,Cox比例风险回归模型进行多因素分析。结果全组随访32~128周,平均随访时间52.8周,125I粒子植入组中位生存期60.3周(95%CI,53.3~67.3周),1 a生存率为71.4%,单纯手术组中位生存期43.1周(95%CI,37.5~48.8周),1 a生存率为36%(P<0.05)1。25I粒子植入组中WHO病理分级Ⅱ、Ⅲ、Ⅳ期的患者1 a生存率分别为87.8%、65.3%、36.4%(P<0.01);肿瘤全切组和次全切的患者1 a生存率分别为79.2%和54.5%(P<0.05)。单因素分析显示,肿瘤组织学分级、肿瘤部位、肿瘤切除程度和放射性并发症是手术联合125I粒子植入治疗复发性胶质瘤的预后影响因素;多因素分析显示肿瘤组织学分级和肿瘤切除程度是影响预后的独立因素。结论手术联合125I粒子植入可有效地延缓脑胶质瘤的生存时间,提高患者的生存率,肿瘤组织学分级和肿瘤切除程度是影响其预后的最重要因素。

Objective To evaluate the survival outcomes and prognostic factors of microsurgical operation combined with 125I seeds brachtherapy.Methods Sixty patients with recurrent malignant glioma after the first surgery,radiotherapy and chemotherapy were randomly divided into 125I seeds implants group（n=35） and pure surgery group（n=25）.All patients were followed up every two months by MRI.The clinical and follow-up data of two groups were collected and analyzed.Their survival rates were calculated by Kaplan-Meier method.The Log-Rank model was used in univariate analyses and Cox regression model in multivariate analysis.Results The follow-up time ranged from 32 to 128 weeks（mean 52.8 weeks）.The median survival time of 125I seeds implants group and pure surgery group was 60.3 weeks（95% CI,53.3~67.3weeks） and 43.1 weeks（95% CI,37.5~48.8weeks）,1-year survival rate was 71.4% and 36%（P0.05）.In 125I seeds implants group,1-year survival rate of WHOⅡ,Ⅲ,Ⅳ were 87.8%,65.3% and 36.4%（P0.01）.1-year survival rates of GTR and STR were 79.2% and 54.5%（P0.05）.Univariate analysis showed that histological grade,extent of tumor resection,tumor location and radioactive complications were prognostic factors.Multivariate analysis showed that histological grade and extent of tumor resection were independent prognostic factors.Conclusion Microsurgical resection combined with 125I seeds implants can improve the survival outcomes of recurrent malignant brain gliomas.Histological grade and extent of tumor resection are the most important prognostic factors.