成人幕上脑胶质母细胞瘤患者临床预后因素研究

Clinical prognostic factors of adult supratentorial glioblastoma

目的探讨成人脑胶质母细胞瘤(GBM)患者的治疗效果和预后因素。方法回顾性分析2007年1月至2018年3月首都医科大学附属北京天坛医院神经外科肿瘤四病区收治的635例GBM患者的临床资料。其中男性386例,女性249例,年龄(48.7±11.8)岁(范围:18~75岁)。按就诊年份将患者分成3组,其中2007—2010年组174例,2011—2014年组237例,2015—2018年组224例。采用Kaplan-Meier法对不同治疗时期的GBM患者的生存期进行分析,组间比较采用Log-rank检验,多因素分析采用Cox风险回归模型。结果2007—2010年组、2011—2014年组、2015—2018年组患者的中位无进展生存期(PFS)和总体生存期(OS)分别为9.0个月(95%CI:7.5~10.5)、10.0个月(95%CI:8.8~11.2)、12.0个月(95%CI:10.7~13.3)和17.0个月(95%CI:13.2~20.8)、20.0个月(95%CI:16.9~23.1)、23.0个月(95%CI:17.5~28.5),随着年份推移,患者PFS和OS均提高,差异有统计学意义(χ^2=9.693,P=0.008和χ^2=8.616,P=0.013)。多因素分析结果显示:年龄、切除程度、放疗和肿瘤远隔播散为独立预后因素(P值均<0.05)。结论随着临床治疗方案不断更新,国内GBM患者治疗效果明显改善,年龄、切除程度、放疗和肿瘤远隔播散是影响患者生存期的独立预后因素。

Objective To analyze the treatment effect of patients with glioblastoma (GBM) and explore prognostic factors. Methods The clinical data of 635 patients diagnosed as GBM at Neurosurgical Oncology Department Ⅳ of Beijing Tiantan Hospital, Capital Medical University from January 2007 to March 2018 were retrospectively reviewed. There were 386 males and 249 females with an age of (48.7±11.8) years (range: 18-75 years). Patients were divided into three groups according to the time of admission: 2007-2010 group(n=174), 2011-2014 group (n=237) and 2015-2018 group (n=224). Kaplan-Meier plot was used to analyze the effects of different treatment periods, treatment schemes and clinical factors on the survival of patients with GBM. Cox proportion hazard regression analysis was used to identify independent prognostic factors. Results The median progression-free survival (PFS) and overall survival (OS) of patients in 2007-2010 group, 2011-2014 group, 2015-2018 group was 9.0 months (95% CI: 7.5-10.5), 10.0 months (95% CI: 8.8-11.2), 12.0 months (95% CI: 10.7-13.3) and 17.0 months (95% CI: 13.2-20.8), 20.0 months (95% CI: 16.9-23.1), 23.0 months(95% CI: 17.5-28.5), respectively. The PFS and OS of patients improved significantly over the years (χ^2=9.693, P=0.008 and χ^2=8.616, P=0.013). Multivariate survival analysis showed that age, extent of resection, radiotherapy and tumor distant dissemination were independent prognostic factors (all P<0.05). Conclusions With the continuous development of clinical treatment regimen, the therapeutic effect of Chinese GBM patients has improved remarkably. Age, extent of resection, radiotherapy and tumor distant dissemination are independent prognostic factors associated with survival time.