胶质瘤复发的病理特征及手术疗效分析

Analysis of pathologic features of recurrent gliomas and therapeutic effect of surgery

目的初步探讨胶质瘤复发的病理特征改变及手术的临床意义。方法回顾性分析2004年1月—2014年1月在上海交通大学医学院附属仁济医院神经外科复发后手术治疗的13例脑胶质瘤患者,比较不同级别胶质瘤复发的病理特征改变及预后。结果 53.8%（7/13）患者出现病理升级,38.5%（5/13）患者病理级别未改变,7.7%（1/13）患者出现降级。复发患者手术后中位生存时间为28个月（2~63个月）,1年生存率为52%,2年生存率为42%。单因素分析显示：复发时病理类型、2次手术间隔〉12个月,初发时磷酸酯酶与张力蛋白同源物（PTEN）复发时p53、Ki-67表达与患者总生存时间显著相关（P〈0.05）。而多因素分析显示：复发时病理类型为复发胶质瘤患者生存的独立预后因素（P=0.031）。结论大部分患者复发时出现病理升级,手术仍能带来生存获益。

Objective To explore the pathological changes of recurrent gliomas and the clinical value of operation.Methods A total of 13 patients with recurrent brain gliomas who underwent surgical treatment at the Department of Neurosurgery of Renji Hospital of Shanghai Jiao Tong University School of Medicine between January 2004 and January 2014 were retrospectively analyzed.The pathological changes of different grades of recurrent gliomas and the prognosis were compared.Results Among all patients,7 of them（53.8%）pathologically upgraded,5 of them（38.5%） remained the same,and one patient（7.7%） pathologically degraded.The median survival time of patients was 28 months（2-63 months）,1 year survival rate was 52%,and 2 year survival rate was 42%.Univariate analysis showed that the pathological level of recurrent gliomas,time between two operations 〉12 months,expressions of phosphatase and tensin homolog deleted on chromosome ten（PTEN） of patients with primary gliomas,and expressions of p53 and Ki-67 of patients with recurrent gliomas were closely correlated with the overall survival time of patients（P〈 0.05）.Multivariate analysis suggested that the pathological level of recurrent gliomas was the independent prognostic factor for the survival of patients（P=0.031）.Conclusion Most patients with recurrent gliomas pathologically upgrade and operation is helpful for the survival of patients.