初诊恶性脑胶质瘤患者综合治疗的生存情况分析

Survival of newly diagnosed malignant glioma patients on combined modality therapy

目的本研究分析初诊恶性脑胶质瘤患者接受包括手术、放疗和化疗在内的综合治疗的生存情况。方法回顾性分析2000年2月至2010年2月中山大学肿瘤防治中心神经外科／神经肿瘤科收治的经综合治疗的122例初诊恶性脑胶质瘤患者的临床资料并行生存随访。患者中位年龄40岁（5—75岁），中位卡氏体力状况评分80分（60—100分）。综合治疗包括：尽可能保全重要神经功能的前提下最大限度手术切除肿瘤；术后2—4周开始局部常规分割外照射辅助放疗，总剂量54—60Gy；放疗结束后2～4周开始辅助化疗4～6个疗程，采用替莫唑胺或亚硝脲类药物为主的方案，或非替莫唑胺非亚硝脲类方案。结果70例Ⅳ级和52例Ⅲ级胶质瘤患者的中位总生存时间分别为17．0和36．0个月，2、3、4及5年总生存率分别为32．0％和64．8％、19．6％和47．8％、11．8％和32．0％、5．9％和25．4％（P〈0．01）；中位无进展生存时间分别为9．0和12．0个月，1、2及3年无进展生存率分别为30．8％和50．0％、12．3％和31．4％、9．2％和17．7％（P〈0．01）。病理类型是影响总生存率及无进展生存率的独立预后因子（P〈0．01）。结论包括手术、放疗和化疗在内的综合治疗可以改善恶性脑胶质瘤患者的生存。

Objective To explore the survival of newly diagnosed maligant gliomas patients on combined modality therapy of surgery, radiotherapy and chemotherapy. Methods The data of 122 newly diagnosed maligant glioma patients on combined modality therapy at our center between 2000 and 2010 were retrospectively reviewed and analyzed. The median age was 40 years old （ range ： 5 - 75 ） and median Karnofsky performance status score （KPS） 80（ range： 60- 100）. Combined modality therapy consisted of surgery （ maximal safety tumor resection） , followed by fraetionated focal irradiation for a total dose of 54 - 60 Gy and then 4 -6 cycles of adjuvant chemotherapy including temozolomide or nitrosourea-based regimens or other ones without temozolomide and nitrosourea. The overall and progression-free survivals were analyzed by the Kaplan-Meier method and the influencing factors screened by Cox proportional hazard model. Results There were grade IV （n =70） and gradeⅢ （n =52）. The median survival periods were 17. 0 months for grade IV patients and 36. 0 months for grade Ⅲ ones. The 2, 3, 4 and 5-year survival rates were 32. 0% vs 64.8%, 19.6% vs47.8%, 11.8% vs 32.0% and 5.9% vs 25.4% （P 〈0.01）for grades IV and II1 patients respectively. The median progression-free survivals were 9.0 vs 12. 0 months and 1, 2 and 3-year progression-free survival rates 30. 8% vs 50.0%, 12. 3% vs 31.4% and 9. 2% vs 17. 7% （P 〈 0. 01 ） respectively. Multivariate analysis revealed that histologic type was an independent prognostic factor. Conclusion Combined modality therapy of surgery, adjuvant radiotherapy and chemotherapy may improve the survival of patients with malignant gliomas.