胶质母细胞瘤切除术后128例预后因素分析

Prognostic implication of clinical and immunohistochemical features in 128 glioblastoma patients

目的探究胶质母细胞瘤(GBM)患者手术切除术后的预后因素。方法收集手术切除的GBM患者的临床资料、免疫组化结果和随访信息,采用Log-rank检验和Cox多因素回归分析检验预后因素。结果本组研究共纳入128例GBM患者。多因素分析结果显示,年龄、肿瘤是否全切、术后是否同步放化疗是GBM患者无进展生存期和总生存期的独立预后因素,术前KPS评分是总生存期的独立预后因素(P<0.05),表皮生长因子受体(EGFR)(P=0.019)和O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)(P=0.001)分别是无进展生存期和总生存期的独立预后因素。另外,MGMT影响术后同步放化疗患者的总生存期(P=0.034)。结论除了年龄、术前KPS评分、肿瘤是否全切和术后是否同步放化疗外,EGFR和MGMT的免疫组化表达是GBM患者术后有预后价值的参考指标,可进一步指导GBM患者的治疗方案。

Objective To investigate the prognostic effects of clinical and immunohistochemical features on glio- blastoma ( GBM) patients.Methods A retrospective cohort of GBM patients treated with surgical resection from January 2008 to March 2017 was analyzed.The clinical and immunohistochemical features and follow - up information were col- lected.The correlations between each potential factor and progression - free survival ( PFS) or overall survival ( OS) were investigated by univariate analyses ( Kaplan - Meier method).Significant factors of univariate analyses were used for mult- ivariate analyses ( Cox proportional hazards regression analysis).Results Overall 128 GBM patients were analyzed.Mul- tivariate analyses demonstrated that age,preoperative Karnofsky performance score ( KPS),extent of surgical resection and chemoradiotherapy ( CRT) were independently correlated with both PFS and OS ( P < 0. 05).The expression of EGFR and MGMT were independently correlated with PFS ( P = 0. 019) and OS ( P = 0. 001).In addition,the MGMT expres- sion also had prognostic value in OS for patients treated with CRT ( P = 0. 034).Conclusion In addition to previously recognized prognostic factors such as age at diagnosis,preoperative KPS,and extent of surgical resection and CRT;the expression of EGFR and MGMT is the independent prognostic factor of PFS and OS in GBM patients respectively.In addi- tion,MGMT expression is an independent prognostic factor of OS in CRT group.