影响幕上WHOⅢ胶质瘤预后的相关因素分析

The factors effecting on the prognosis of WHO grade Ⅲ glioma

背景与目的:近年来,国外开展了多宗关于胶质瘤预后因素评估的临床研究,而此类研究在国内尚为数不多。本文旨在以中国人群为样本,分析影响胶质瘤预后相关因素,为临床提供理论依据。方法:收集2009年5月至2010年12月北京天坛医院神经外科四病区外科手术治疗的109例原发性WHOⅢ胶质瘤患者的资料。生存分析中单因素分析采用Kaplan-Meier计算生存率,并采用Log-rank检验进行生存率比较;多因素分析使用Cox比例风险模型,采用逐步回归分析法。结果:单因素分析结果显示病理类型、年龄、1p/19q、IDH1、MGMT与患者预后相关(P<0.05);多因素分析结果显示病理类型、年龄、1p/19q为独立预后因素,而IDH1、MGMT则不能作为独立预后因素。结论:病理类型、年龄、1p/19q可作为评估幕上WHOⅢ胶质瘤患者的独立预后因素;1p/19q共缺失可能是MGMT低表达作为评估患者预后因素的前提条件,而1p/19q共缺失则很可能是通过降低MGMT表达量而增加了患者化疗、放疗敏感性来延长患者的生存期。

BACKGROUND ＆ OBJECTIVE： Recently, several clinical trials which devoted to ascertaining the factors influencing the prognosis of glioma patients had been projected. In China, similar trials were limited. This study which based on Chinese patients with grade III gliomas was designed to assess the roles of several factors in prognosis and provide theoretical reference to clinical treatment. METHODS： A series of 109 grade Ⅲ glioma patients surgically treated and pathologically confirmed in Beijing Tiantan Hospital from May 2009 to December 2010 were respectively reviewed in the study. For the univariate analysis, survival probabilities were estimated based on Kaplan-Meier method and Log-rank test. Multivariate regression analysis using Cox＇s proportion- hazards model showed the effects of these factors on survival. RESULTS： Univariate analysis revealed that histology type, age, lp/19q, IDH1, and MGMT were all correlated with survival （P〈 0.05）. However, only histology type, lp/19q co-deletion and age was confirmed by Cox regression （P〈 0.05）. CONCLUSION： Both histology type, age and lp/19q co-deletion are independent predictive factors for survival. MGMT expression is a predictive factor for survival that is dependent on lp/19q co-deletion. Perhaps lp/19q co-deletion is the prerequisite for MGMT lower expression to predict longer survial and lp/19q co-deletion prolong survival by decreasing MGMT expression.