影响脑干胶质瘤放射治疗预后的相关因素分析

Prognostic factors analysis of brainstem glioma

目的回顾性分析放射治疗的脑干胶质瘤病例，探讨肿瘤的预后及其影响因素。方法2009年7月至2011年12月收治病理确诊的脑干胶质瘤患者54例，随访患者总生存率，对相关指标进行单因素及多因素分析，运用预后指数模型综合评价放疗疗效。结果全组患者中位生存时间17．5个月，1年、3年总生存率分别为83％和61％。单因素及多因素分析显示WHO低分级、病灶局限于单一解剖部位的患者预后较好P〈0．05。预后指数能够更好的预测脑干胶质瘤患者的预后。结论WHO分级及病灶是否局限于单一解剖结构有可能成为脑干胶质瘤放射治疗的独立预后因素，预后指数模型能够显著提高多指标联合的预测价值。

Objective A retrospective analysis was carried out to evaluate the prognosis and Influence factors of brain stem gliomas （BSG）. Methods From Jul. 2009 to Dec. 2011, 54 patients with pathological diagnosis of WHOⅠ-Ⅳ BSG received definitive radiotherapy and eligible for the analysis. In all patients, 21 cases accepted subtotal resection,27 cases accepted partial resection and 6 accepted biopsy; 16 cases accepted intensity- modulated radiation therapy （IMRT） and 38 cases accepted three dimensional radiotherapy（3DCRT ） , 1.8-2.0 Gy/f ,total dose（DT） was 45 -60 Gy, the median DT was 50.4 Gy; 24 cases accepted concurrent chemoradiotherapy of temozolomide and 30 cases accepted radiation alone. The significance of related prognostic factors were evaluated by univariate and multivariate analysis. The value of each prognostic factor in the survival was added up to calculate the prognostic index（PI）. Results In all patients, the median survival time was 17. 5 months. The overall survival rate of 1 year and 3 year was 83% and 61%, respectively. Univariate and multivariate analysis showed that with a low WHO grade and lesion confined to a single anatomic site gave a better survival. Conclusion Low WHO grade and lesion confined to a single anatomic site are likely to be independent prognostic factors. Prognostic index model can predict the prognosis of BSG more effectively than single variable.