高分级脑胶质瘤术后精确放疗预后影响因素分析

Prognostic factors of postoperative patients of high-grade gliomas treated with precise radiotherapy

目的：回顾性分析高分级脑胶质瘤（highgradeglioma，HGG）术后精确放疗预后及其影响因素。方法：回顾性分析山西省肿瘤医院放射治疗中心2007—09—2012-03收治的HGG术后患者66例，均行手术治疗，其中肉眼全切36例，次全切除术30例。术后25例行三维适形放疗（three-dimensionalconformalradiationtherapy，3DCRT），41例行调强放疗（intensitymodulatedradiationtherapy，IMRT）。手术至放射治疗的间隔时间8～201d，中位时间35d。放疗总剂量30-78Gy，中位剂量60Gy。Kaplan-Meier法进行生存率的计算，Logrank进行单因素分析，用Cox回归行多因素分析。结果：全组1和3年总生存率分别为74．9％和39．4％，中位生存时间为19．93个月。单因素分析显示，放疗前KPS评分（χ2=4．575，P=0．032）、病理分级（χ2=7．201，P=0．007）、手术切除程度（χ2=18．770，P〈0．001）、年龄（χ2=5．245，P=0．022）和术前癫痫发作（χ2=18．356，P〈0．001）是影响HGG术后放疗生存率的重要因素。多因素分析显示，病理分级（P=0．001）、放疗前KPS评分（P=0．017）、肿瘤切除情况（P〈0．001）和术前癫痫发作（P〈0．001）是影响HGG术后放疗1和3年生存率的独立因素。结论：病理分级低、放疗前KPS评分≥80、手术全切和术前癫痫症状均影响GCG患者术后精确放疗的预后。

[ABSTRACT] OBJECTIVE：To retrospectively analyze the postoperative patients of high-grade gliomas treated with pre- cise radiotherapy. METHODS：The data of 66 patients with HGG treated by postoperative radiotherapy were retrospective- ly analyzed. Thirty-six patients received total resection and 30 patients received subtotal resection. Twenty-five patients were treated with Three-dimensional Conformal Radiation, and 41 patients were treated with Intensity-modulated Radia- tion. The waiting time from operation to radiotherapy was between 8 and 201 days （the median waiting time was 35 days）. The radiation dose was between 30 and 78 Gy （the median dose was 60 Gy）. The survival rate was caculated by K- M, the Log-rank was used for univariate analysis,and Cox model was used for multivariate analysis. RESULTS： The 1-year and 3-year over all survival rates were 74.9% and 39.4% respectively,and the median survival time was 19.93 months. Univariate analysis showed that KPS score （χ2 = 4.575, P = 0. 032）, pathological grade （χ2 = 7.201, P = 0. 007）, the ex- tent of surgical resection （χ2= 18. 770,P〈0. 001）,age（χ2 = 5. 245,P=0. 022） and epilepsy（χ2= 18. 356,P〈0. 001） were the important factors affecting the survival time. Multivariate analysis showed that pathological grade（P = 0. 001）, KPS score （P=0. 017）before radiotherapy,the extent of surgical resection（P〈0. 001） and epilepsy （P〈0. 001） were the independent factors affecting the 1-year or 3-year survival rate of high-grade gliomas treated by postoperative radiothera- py. CONCLUSION： Low pathological grade,KPS score before radiotherapy≥80, total resection and epilepsy before surger- y are better prognostic factors.