低级别胶质瘤T2Flair体积与预后的相关性研究

Factors associated with T2Flair volume on patients' prognosis with low-grade glioma

目的探讨术前、术后残留T2Flair体积对低级别胶质瘤预后的影响及相关因素分析。方法回顾性分析广东三九脑科医院2011年10月份至2015年9月病理确诊的47例WHO II级胶质瘤病例,所有病例采取了唤醒麻醉或非唤醒方式开颅切除肿瘤,术后均接受辅助放疗。收集患者术前、术后48小时内MRI-Flair图像,用Brainlab-i Plan软件定量计算术前及术后残余T2Flair体积。采用SPSS20.0统计软件进行生存分析,Kaplan-Meier法计算无进展生存率并行log-rank检验。结果 47例患者术前T2Flair中位体积80.01 ml(4.28~278.62 ml),术后残留T2Flair中位体积37.58ml(1.41~227.91 ml);中位随访时间37个月(18~65个月),7例失访,6例复发,2例死亡,5年无进展生存率80.2%;生存预后的单因素分析显示如下:年龄(<45岁与≥45岁)χ~2=0.026,P=0.873;病理类型(星形细胞瘤,少突胶质瘤,少突星形细胞瘤)χ~2=2.142,P=0.343;病变部位(额颞岛叶与非额颞岛叶)χ~2=4.069,P=0.044;术前体积(<46 ml与≥46 ml),χ~2=5.372,P=0.020;术后残留体积(<27 ml与≥27ml),χ~2=4.349,P=0.037。对术前体积≥46 ml的病例进一步分析,唤醒麻醉组T2Flair平均切除程度52.5%,全麻组T2Flair平均切除程度35.8%,P=0.035。结论 T2Flair术前体积及术后残留体积是影响低级别胶质瘤患者无进展生存时间的不良因素,唤醒麻醉可提高肿瘤T2Flair最大安全范围切除程度。

Objective To explore the effect of preoperative and postoperative T2Flair volume and relevant factors on patients＇ prognosis with low-grade glioma. Methods A retrospective study of 47 cases were performed who was diagnosed as glioma of WHO II grade in pathology at Guangdong 999 Brain Hospital,during the period from October 2011 to September 2015. All of the cases underwent a surgery under awake anethesia or general anethesia and received an adjuvant radiotherapy. Patients＇ MRI-Flair images before operating and after operating in 48 hours were collected to calculate preoperative and postoperative T2Flair volume by using Brainlab-i Plan software. Survival analysis was conducted by using SPSS20. 0 statistical software and Kaplan-Meier method was used to calculate the progression-free survival rate,and we took a log-rank test. Results Median preoperative and postoperative T2Flair volume of 47 cases are respectively 80. 01cc（ 4. 28 ml-278. 62 ml） and 37. 58cc（ 1. 41 ml-227. 91 ml）. During a median follow-up period of 37 months（ 18 months-65 months） after surgery,7 cases were out of contact,6 cases relapsed and 2 cases died,and the rate of 5-year progression-free survival（ PFS） was80. 2%. A single factor analysis of survival prognosis showed as following： Age（ 〈45 years old or ≥45 years old）,χ^2= 0. 026,P = 0. 873; Pathologic type（ astrocytoma,oligodendrocytoma,oligodendrocytoma）,χ^2= 2. 142,P = 0. 343; Location（ frontotemporal and insular lobes,non-frontotemporal and insular lobes）,χ^2= 4. 069,P = 0. 044; Preoperative T2flair volume（ 46 mlor ≥46 ml）,χ^2= 5. 372,P = 0.020; Postoperative residual volume（ 27 mlor ≥27 ml）,χ^2= 4. 349,P = 0. 037. We further analysed those cases whose preoperative T2flair volume were greater than 46 cc,the average resection degree of T2flair were respectively 52. 5% and 35. 8% for awake anesthesia group and general anesthesia group（ P= 0. 035）. Conclusion Preoperative and postoperative T2Flair volume are negative PFS predictors in patients with low-grade glioma. Awake anesthesia increases the resection degree of tumor T2Flair volume in a maximum safety range.