复发脑胶质瘤再手术疗效的影响因素分析

Clinical analysis of prognostic factors in re-operation for recurrent glioma

目的探讨复发脑胶质瘤再手术的适应证及预后影响因素。方法对42例复发脑胶质瘤接受再手术的临床资料进行回顾性分析。结果24例为镜下全切除,18例为次全或大部分切除,无手术死亡病例;再手术前卡氏预后评分(Karnofsky Performance Status,KPS)平均(74.5±11.7)分,再手术后平均(82.3±11.6)分;再手术后生存期为2～87个月,平均(21.2±3.7)个月。经单因素分析再次手术前KPS评分、初次术后病理级别、发现病灶复发时距初次手术的时间、再手术肿瘤切除程度及再次手术后辅助治疗是影响再次术后生存期的因素;多因素分析提示再次术前KPS评分高、发现病灶复发时距初次手术的时间长是预后保护因素,而再次术后病理级别高为预后的危险因素。结论术前KPS≥70分,病理WHOⅠ-Ⅱ级,发现病灶复发时距初次手术的时间≥6个月的复发脑胶质瘤患者再手术治疗效果较好。

Objective To investigate indications, prognostic factors of the patients undergoing re-operation for recurrent intracranial gliomas. Method Clinical data of 42 patients receiving reoperation with recurrent intracranial gliomas were retrospectively analyzed. Results Twenty-four cases underwent total tumor resection and 18 cases had subtotal tumor removal, respectively. There was no surgery related death in this group of patients. The mean scores for the Kamofsky performance status （KPS） were significantly increased from 74.5 to 82.3 after re-operation. The survival time of the patients after re-operation was 2 to 87 months （mean 21.2 months）. Univariate analysis showed that the KPS score before re-operation, primary pathologic grade, interval between primary operation and focal recurrence, surgical excision extent in the re-operation and adjunctive therapy following re-operation were related with the survival time after re-operation. Multivariate analysis showed that the higher KPS score before re-operation and longer interval between primary operation and focal recurrence were favorable factors for the prognosis, while the higher pathologic grade of the tumor at the secondary surgery was risk factor. Conclusion Re-operation is effective for the recurrent glioma patients with the KPS score ≥ 70 before re-operation, interval between primary operation and focal recurrence ≥ 6 months and pathologic diagnosis of WHO grade I - II.