Ⅲ级和Ⅳ级脑胶质瘤术后放化疗预后分析

Prognostic analysis of postoperative chemoradiotherapy in patients with grade HI/IV glioma

目的评价Ⅲ、Ⅳ级脑胶质瘤术后放化疗的疗效及预后因素。方法回顾分析2007—2012年问119例Ⅲ、Ⅳ级脑胶质瘤术后放疗或放化疗患者的临床资料，其中单纯放疗49例，放疗联合亚硝脲类化疗21例，放疗联合替莫唑胺化疗49例。采用Kaplan—Meier法计算总生存率和复发率，Cox模型多因素预后分析。结果随访率为94．1％，随访时间满1、2年样本数分别为53、10例。总复发率69．7％。1、2年总生存率分别为d4．5％、8．4％。多因素分析显示年龄、术前有无癫痫发作、肿瘤切除程度、放疗联合替莫唑胺化疗均是影响肿瘤复发的因素（P=0．002、0．005、0．000、0．000），上述因素加上肿瘤病理分级是影响患者生存的因素（P=0．006、0．010、0．000、0．000、0．001）。结论Ⅲ、Ⅳ级脑胶质瘤术后患者放疗联合替莫唑胺化疗可取得较好疗效，同时年龄〈60岁、术前无癫痫发作、肿瘤全切、肿瘤病理分级Ⅲ级是影响恶性胶质瘤患者长期生存的有益因素。

Objective To evaluate the treatment outcome and prognostic factors in patients with gradeIII/IV glioma following postoperative chemoradiotherapy. Methods A retrospective analysis was performed on the medical records of 119 patients with gradeIII/IV glioma who received treatment in our hospital from January 2007 to April 2012. Of the 119 patients, 49 received radiotherapy alone, 21 received radiotherapy combined with nitrosoureas, and 49 received radiotherapy combined with temozolomide. The Kaplan-Meier method was used to calculate overall survival （OS） rates and recurrence rates. The Cox regression model was used for multivariate prognostic analysis. Results The follow-up rate was 94. 1%. Fifty-three patients were followed up for at least 1 year, and 10 for at least 2 years. The overall recurrence rate was 69.7%. The 1-and 2-year OS rates were 44. 5% and 8. 4% , respectively. The multivariate analysis showed that age, presence or absence of seizures before surgery, extent of tumor resection, and radiotherapy plus concurrent and adjuvant temozolomide were the main prognostic factors for tumor recurrence （ P = 0. 002, 0. 005, 0. 000, and 0. 000 ）. The above factors and the pathological grade of tumor were the independent prognostic factors for patients＇ survival （ P = 0. 006, 0. 010, 0. 000, 0. 000, and 0. 001 ）. Conclusions Postoperative radiotherapy plus concurrent and adjuvant temozolomide produce a good clinical effect in patients with grade III/IV glioma. Age of 〈 60 years, no seizures before surgery, total tumor resection, and pathological gradeIII of tumor are the favorable prognostic factors for the long-term survival in patients with malignant glioma.