高级别脑干胶质瘤同步放化疗疗效及影响因素

Efficacy and influence factors of concurrent radiotherapy and chemotherapy for high-grade brainstem glioma

目的:回顾性分析经活检或手术后明确的成人高级别脑干胶质瘤患者接受替莫唑胺标准放化疗的预后及影响因素。方法:选取首都医科大学附属北京天坛医院2012年6月至2013年12月收治高级别脑干胶质瘤患者,接受活检或病灶切除手术证实为高级别胶质瘤(WHOⅢ级和Ⅳ级),并完成标准同步放化疗和至少2个周期替莫唑胺5/28天方案辅助化疗的患者29例,收集患者临床和随访信息,应用Cox回归模型对相关变量进行单因素及多因素分析。结果:全组患者中位总生存期(overall survival,OS)为11.5个月,单因素分析显示,Ⅲ级vs.Ⅳ级,HR=0.386(95%CI:0.164~0.911,P=0.030),差异具有统计学意义,提示病理级别对患者预后具有显著影响。而性别、年龄、起病至接受手术的时间、病灶大小、手术方式以及贝伐珠单抗使用情况等对预后的影响差异均无统计学意义(P>0.05);多因素分析显示,KPS评分高(>60分)和较低级别(Ⅲ级)与患者良好预后相关,差异具有统计学意义(P=0.005,P=0.011)。结论:病理分级低和KPS评分高是成人高级别脑干胶质瘤是患者预后的有利因素。

Objective: To perform a retrospective analysis of the prognosis and influence factors of radiotherapy concurrent with chemotherapy and adjuvant temozolomide therapy in adult patients with high-grade brainstem glioma. Methods: Twenty-nine patients with pathological diagnosis of high-grade glioma(World Health Organization [WHO] Ⅲ and Ⅳ) from June 2012 to December 2013 were eligible for inclusion in the analysis. Demographic and clinical characteristics including age, gender, the time from morbidity to operation, the size of the lesion, the method of operation, the Karnofsky Performance Status(KPS) score, and the pathological grade were examined. The significance of related prognostic factors was evaluated via univariate and multivariate Logistic regression analysis. A P-value of <0.05 was considered to be statistically significant. Results: The median overall survival(OS) was 11.5 months. Univariate analysis showed that low WHO grade index was associated with better outcome(P<0.05). Multivariate analysis suggested that high KPS score(>60) and low WHO grade were associated with better survival. Conclusions: In this study, low pathological grade and high KPS score were independently associated with better survival among patients with high-grade brainstem glioma.