89例术后高度恶性脑胶质瘤预后影响因素分析

Analysis of prognosis of 89 patients with postoperative high-grade glioma

目的:探讨高度恶性脑胶质瘤的预后以及预后影响因素。方法:回顾分析江西省肿瘤医院2005年4月至2011年2月收治的89例高度恶性脑胶质瘤的临床资料,其中手术全切43例,部分切除46例;WHO3级45例,4级44例。结果:全组中位生存期13个月,2年总生存率(OS)及无进展生存率(PFS)分别为43.2%和36.9%;单因素分析显示切除程度、病理分级、年龄是OS的影响因素(P<0.05),切除程度、脑室系统受侵、术后放疗是PFS的影响因素(P<0.05),多因素分析结果显示切除程度、年龄是OS的独立影响因素(P<0.05);切除程度、术后放疗是PFS的独立影响因素(P<0.05);全组共41例复发,其中原位复发65.9%,远隔部位复发34.1%;46例脑室系统受侵者,11例出现远隔部位复发;其余43例,仅3例出现远隔部位复发。结论:手术切除程度、年龄是影响OS的独立预后因素,术后放疗能改善PFS;原位复发是主要复发模式,脑室受侵增加了远处播散概率。

Objective： This study discusses the prognosis and prognostic factors of postoperative high-grade glioma. Methods： Eighty-nine patients with postoperative high-grade glioma were registered at the Jiangxi Province Tumor Hospital between April 2005 and February 2011. Total and partial removal of glioma were performed in 43 and 46 patients, respectively. Based on the World Health Orga- nization （WHO） grading system of glioma, 45 patients in this study had WHO grade ]]I glioma and 44 patients had WHO grade IV glioma. Results： The results show that the median survival time of patients with glioma was 13 months. The two-year overall survival rate （OS） was 43.2%, and the two-year progression-flee survival rate （PFS） was 36.9%. The prognostic factors of OS identified in univariate analysis include age, pathological grade, and resection extent （P〈0.05）. However, the independent prognostic factors in multivariate analysis only include resection extent and age （P〈0.05）. The prognostic factors of PFS in univariate analysis include resection extent, postoperative radiotherapy, and ventricle violated before surgery （P〈0.05）. However, the independent prognostic factors in multivariate analysis only include resection extent and postoperative radiotherapy （P〈0.05）. In this study, tumor recurrence occurred in 41 patients, 65.9% patients had tumor bed failure, and 34.1% had distance failure. Among the 46 patients with damaged ventricles before surgery, 11 displayed distant recurrence. Among the 43 patients who underwent total removal of glioma, 3 had distant metastasis before surgery Conclusion： Resection extent and age are the independent prognostic factors of overall survival in glioma, and postoperative radiotherapy can improve the progression-free survival of patients. The major pattern of failure is tumor bed recurrence. However, distance failure increases when the ventricle is damaged.