影响岛叶胶质瘤预后的多因素分析

Influence factors affecting insular gliomas prognosis

目的探讨影响岛叶胶质瘤患者预后的主要因素。方法回顾性分析上海长征医院神经外科自2002年4月至2011年4月采用显微手术治疗的58例岛叶胶质瘤患者的临床资料，通过随访获得其总体生存时间（0S）和无进展生存期（PFS），对影响患者预后的因素分别进行单因素（Logrank检验1及多因素（Cox回归1分析。结果58例岛叶胶质瘤患者均接受显微手术治疗，其中33例（56．9％）全切除，12例（20．7％）次全切除，12例（20．7％）部分切除，1例（1．7％）活检。24例（24／26，92.3％）高级别胶质瘤患者在术后接受规范化的放化疗，21例（21／32，65．6％）低级别胶质瘤术后接受了放化疗。58例患者的OS中位值为29．0月，PFS中位值为25．0月；5年生存率为46％，截至随访结束生存率为33％。统计结果表明术前Kamofsky功能状态评分（KPS）、病理级别及切除程度是影响患者预后的独立因素。结论岛叶胶质瘤的显微手术应在保护重要血管穿支及功能区，避免发生并发症的情况下尽可能最大程度切除肿瘤，藉此可显著改善患者预后。

Objective To investigate the factors affecting the prognosis of insular gliomas. Methods A series of 58 insular gliomas patients, admitted to and received microsurgical treatment in our hospital from April 2002 to April 2011, were chosen in our study; their clinical data were retrospectively reviewed and analyzed. The overall survival time （OS） and progression-free survival time （PFS） were calculated; univariate analysis （Log rank test） and multivariate analysis （Cox regression） were used to estimate the risk factors for patients＇ prognosis. Results The majority of 58 patients received aggressive treatment, with gross total resection in 33 （56.9%）, sub-total resection in 12 （20.7%）, partial resection in 12 （20.7%） and biopsy in only 1 （1.7%）. In a11, 92.3% high-grade gliomas patients （24/26） received adjuvant chemotherapy and radiotherapy. In 32 low-grade gliomas patients, 21 （65.6%） received adjuvant chemotherapy and radiotherapy. The median OS was 29.0 months, and the median PFS was 25.0 months. Five years of survival rate was 46%, and till the follow-up deadline, the survival rate was 33%. KPS, grade of pathology and extent of resection were the independent prognostic factors for both OS and PFS. Conclusion In the protection of important structures and avoidance of complications, an aggressive management of optimal resection is associated with better outcome in patients with insular gliomas.