锥体束受侵犯程度与岛叶胶质瘤患者术后疗效的关系

Relationship between the degree of pyramidal tracts invasion and postoperative outcome in patients with insular glioma

目的探讨锥体束受侵犯程度与岛叶胶质瘤患者术后疗效的关系。方法回顾性分析2010年7月至2019年7月于中国科学技术大学附属第一医院(安徽省立医院)神经外科行手术治疗的41例岛叶胶质瘤患者的临床资料。根据MRI显示锥体束受侵犯程度将患者分为3型,其中肿瘤仅侵犯岛叶前下部为Ⅰ型,侵犯岛叶后上部为Ⅱ型,浸润破坏内囊结构为Ⅲ型。分析各型患者术前、术后肢体运动功能障碍,病理学类型及术后疗效的差异。结果41例患者中,Ⅰ型18例(43.9%),Ⅱ型20例(48.8%),Ⅲ型3例(7.3%)。Ⅰ型患者术前、术后均无运动功能障碍。Ⅱ型患者术前4例有运动功能障碍,其中3例术后得到了改善,1例症状进一步加重,1例术后新发生了运动功能障碍。Ⅲ型患者术前均有运动功能障碍,术后症状均进一步加重。Ⅰ、Ⅱ、Ⅲ型肿瘤全切除者分别有11例、5例、1例,与Ⅰ型比较,Ⅱ+Ⅲ型肿瘤全切除比例低[分别为26.1%(6/23),11/18],差异有统计学意义(P=0.026);Ⅰ、Ⅱ、Ⅲ型患者中,世界卫生组织(WHO)Ⅲ~Ⅳ级胶质瘤患者分别有3例(3/18)、7例(7/20)、3例(3/3),差异有统计学意义(P=0.015)。术后29例获3~72(22.7±12.0)个月的随访。Ⅰ型患者随访13例,均未复发;Ⅱ型患者随访15例,其中7例复发;Ⅲ型患者随访1例,术后第3个月因残留肿瘤增大而死亡。Kaplan-Meier生存分析3型患者的生存率差异有统计学意义(P<0.01)。结论锥体束受侵犯程度越重,岛叶胶质瘤的病理学级别越高,手术全切除率越低,术后疗效越差。

Objective To explore the clinical study of the extent of pyramidal tract invasion and the postoperative outcome of insular gliomas.Methods The clinical data of 41 patients with insular glioma undergoing surgical treatment from July 2010 to July 2019 at Department of Neurosurgery,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)were retrospectively analyzed.Patients were classified into 3 types according to the degree of invasion of pyramidal tracts.The tumor invading only the anterior lower part of the insular lobe was categorized as typeⅠ,that invading posterior upper part of the insular lobe as typeⅡ,and that with invasion and destruction of the inner capsule structure as typeⅢ.The differences of limb motor dysfunction before and after operation,pathological types and postoperative outcome among patients with different types were analyzed.Results Among the 41 patients,18 were typeⅠ(43.9%),20 were typeⅡ(48.8%),and 3 were typeⅢ(7.3%).No typeⅠpatients had motor impairment before or after surgery.Four patients with typeⅡtumor had motor dysfunction before surgery,of whom 3 reported improvement after surgery and 1 developed further worsened symptoms.One typeⅡpatient had new motor dysfunction after surgery.TypeⅢpatients had motor dysfunction before operation,and their symptoms worsened after operation.There were 11 cases,5 cases,and 1 case of total resection of typeⅠ,typeⅡ,and typeⅢtumors,respectively.Compared with the rate of total resection in typeⅠpatients,that in typeⅡ+Ⅲpatients was significantly lower[26.1%(6/23)vs.11/18,P=0.026].There were 3 cases,7 cases,and 3 cases of World Health Organization(WHO)gradeⅢ-Ⅳglioma in patients of typeⅠ,ⅡandⅢ,respectively.The difference was statistically significant(P=0.015).A total of 29 cases were followed up for 3-72 months(22.7±12.0 months).Thirteen patients with typeⅠwere followed up,and none of them recurred.Fifteen patients with typeⅡwere followed up,7 of whom relapsed.One patient with typeⅢwas followed up,and the residual tumor increased and the patient died in the third month after operation.Kaplan-Meier survival analysis revealed significant difference in the survival rate among the patients of 3 types(P<0.01).Conclusion The heavier the pyramidal tacts is invaded,the higher the pathological grade of insular glioma,the lower the total surgical resection rate,and the worse the postoperative outcome.