173例胶质瘤预后的影响因素分析

Prognostic factors for gliomas: analysis of 173 cases

目的探讨影响胶质瘤预后的相关因素。方法对2000年1月至2009年12月在中山大学肿瘤防治中心首次手术病理确诊为胶质瘤的临床资料进行回顾性分析,并排除因非肿瘤因素死亡患者,采用Kaplan-Meier法进行生存率估计及Cox比例风险回归模型进行预后多因素分析。结果本组纳入胶质瘤173例,其中WHOⅠ级10例,Ⅱ级61例,Ⅲ级53例,Ⅳ级49例;98例术后接受放疗[高级别胶质瘤（WHOⅢ～Ⅳ级）61例,低级别胶质瘤（WHOⅠ～Ⅱ级）37例];60例术后接受化疗（高级别胶质瘤46例,低级别胶质瘤14例）。本组患者1、3、5年总体生存率分别为74.0%、42.2%、32.4%;WHOⅠ、Ⅱ、Ⅲ、Ⅳ级的5年生存率分别为80.0%、52.5%、24.5%、6.1%。分层分析显示术后辅助放化疗显著影响高级别胶质瘤生存率（P〈0.05）。Cox比例风险回归模型分析结果显示,年龄〉40岁（RR=1.603;P=0.019）、WHOⅢ～Ⅳ分级（RR=2.311;P〈0.001）、肿瘤未全切（RR=2.108;P〈0.001）、术后未放疗（RR=1.652;P=0.008）是影响胶质瘤总体生存率的独立危险因素。结论本组病例的分析结果提示,发病年龄≤40岁、WHO级别低、肿瘤全切的胶质瘤患者预后好;术后进行放疗可以提高胶质瘤的疗效。

Objective To analyze the prognostic factors for patietns with gliomas.Methods The clinical data of 173 patients withpathologically confirmed gliomas at Sun Yat-sen University Cancer Center from January of 2000 to December of 2009 were analyzedretrospectively. Survival was estimated by Kaplan-Meier analysis. The univariateand multivariate analysis of the factors related to theprognosis was performed.ResultsAmong 173 patients, 10（5.8%） were diagnosed with WHO grade Ⅰ gliomas, 61（35.3%） with grade Ⅱgliomas, 53（30.6%） with grade Ⅲ gliomas and 49（28.3%） with glioblasto mamultiforme, respectively. Of 98 patients who receivedpostoperative radiotherapy, 61 had high-grade gliomas（WHO grades Ⅲ and Ⅳ） and 37 low-grade gliomas（WHO grades Ⅰ and Ⅱ）,respectively. Of 60 patients who received adjuvant chemotherapy, 46 had high-grade gliomas and 14 low-grade gliomas, respectively.The 1-, 3- and 5-year overall survival of 173 patients was 74.0%, 42.2% and 32.4%, respectively. The 5-year overall survival of thepatients with gliomas of WHO grade Ⅰ, Ⅱ, Ⅲ and Ⅳ was 80.0%, 52.5%, 24.5% and 6.1%, respectively. The univariate analysisshowed that gender, age, preoperative seizure, histological grade, tumor location（supratentorial or subtentorial） and extent of resection（total or partial） were factors related to the prognosis for patients with gliomas. The stratified analysis by log-rank test revealed thatadjuvant radiotherapy was a prognostic factor for patients with high-grade gliomas but not for those with low-grade gliomas. Breslow testindicated that adjuvant chemotherapy was a prognostic factor for patients with high-grade gliomas. The multivariate analysis showed thatthe prognostic factors included age（≤40 or 40 years）, histological grade, the extent of resection and post-operative radiotherapy forglioma patients.Conclusions The results showed that the age ≤40 years, gliomas of lower grade and total resection of tumor wereassociated with improved overall survival in the patients with gliomas. The patients with high-grade gliomas and the patients with acertain subgroup of low-grade gliomas may benefit from post-operative radiotherapy and adjuvant chemotherapy.