31例恶性神经鞘瘤的疗效与预后因素分析

Therapeutic Effect and Prognostic Analysis of 31 Cases with Malignant Schwannoma

目的探讨恶性神经鞘瘤的临床特点、治疗和预后影响因素。方法分析31例恶性神经鞘瘤临床资料,应用Kaplan-Meier和Cox回归分析研究各因素对预后的影响。结果 31例中24例行手术加放射治疗,总剂量12～84Gy,中位剂量74.97Gy,7例单纯行手术治疗。症状缓解(消失+改善)率为96.8%,肿瘤消退(完全+部分消退)率为93.6%;在治疗后3个月至2年,31例中10例(32.3%)神经、肢体功能损伤症状较治疗结束时明显改善,3例完全恢复。肿瘤复发13例,肿瘤转移7例,肺转移常见(57.1%)。5年总生存率、5年无进展生存率分别为54.8%、35.5%。单因素分析显示影响年总生存率的因素有姑息性手术、姑息性放疗、术后复发、术后转移、症状未完全消失、肿瘤残存;影响5年无进展生存率的因素有姑息性手术、姑息性放疗、症状未完全消失。多因素分析显示以上因素均不是独立预后因素。结论恶性神经鞘瘤易出现复发及转移,肺转移常见,完整手术切除和术后根治性放疗是最有效的治疗方法。本研究未发现恶性神经鞘瘤的独立预后因素。

Objective To explore the clinical features,treatment methods and prognostic factors of malignant schwannoma.Methods 31 patients with malignant schwannoma was retrospectively reviewed.Of 31cases,24 cases performed routine operations and radiation therapy and 7 cases performed simple operations.Kaplan-Meier and Cox regression were applied to analyze the prognostic factors.Results The symptom remission rate（disappearance and improvement） was 96.8%,and meanwhile tumor regression rate（complete and partial） was 93.6%.After 3 months to 2 years of the treatment,10 cases（accounting for 32.3%） experienced considerable improvement in nervous and limb function injury,compared with that as the treatment ended.The overall survival rate and the progression free survival rate were 54.8% and 35.5% of the whole group during the five-year period,respectively.Single factor analysis indicated that the adverse factors affecting OS in this period included palliative operation,palliative radiotherapy,postoperative recurrence and postoperative metastasis,the symptoms did not completely disappear,tumor remnants,while those factors affecting PFS were palliative operation,palliative radiotherapy and the symptoms not totally disappear.Multiple factors analysis revealed that the above mentioned factors were all not the independent prognostic factor.Conclusion Malignant schwannoma occurs in various parts of the body,and body mass is the common symptom.Tumors tend to have a relapse,metastasis and pulmonary metastasis.Complete excision operation and postoperation radical radiotherapy are proven to be the most effective method.Our research has not discovered the independent prognostic factors of 31 patients with malignant schwannoma.