无症状WHOⅡ级脑胶质瘤的疾病特征和术后生存分析

Clinical characteristics and postoperative survival of asymptomatic patients with WHO gradeⅡgliomas

目的分析无症状世界卫生组织(WHO)分级Ⅱ级脑胶质瘤的疾病特征和术后生存情况。方法回顾性分析2011年1月至2016年12月郑州大学第一附属医院神经外科手术治疗的271例WHOⅡ级脑胶质瘤患者的临床资料。将其分为无症状组(34例)和有症状组(237例)。对比分析两组患者疾病特征和预后的差异。多因素Cox回归分析方法分析影响预后的危险因素。结果与有症状组比较,无症状组肿瘤侵犯功能区的比率较低[分别为58.2%(138/237)、38.2%(13/34),P=0.041],年龄、性别、组织学类型、异柠檬酸脱氢酶(IDH)和端粒酶逆转录酶启动子(TERTp)是否突变、1p/19q是否共缺失,两组比较差异均无统计学意义(均P>0.05)。无症状组和有症状组术后肿瘤的全切除率分别为94.1%(32/34)、78.5%(186/237),行放疗的比率分别为97.1%(33/34)、78.5%(186/237),差异均有统计学意义(均P<0.05)。所有患者的随访时间为1.1~86.0个月(中位数为43.0个月),无症状组和有症状组的复发率分别为8.8%(3/34)、27.4%(65/237),中位生存期分别为45.5(28.5~80.0)个月、43.0(1.1~86.0)个月,差异均有统计学意义(均P<0.05)。Kaplan-Meier生存分析显示,随访期无症状组的总体生存率和无进展生存率均高于有症状组,差异均有统计学意义(均P<0.05)。多因素Cox回归分析结果显示,侵犯功能区(HR=2.048,95%CI:1.017~4.125,P=0.045)和复发(HR=0.009,95%CI:0.002~0.038,P<0.001)是患者术后生存的独立危险因素。而有、无症状不是术后生存的独立影响因素(HR=1.570,95%CI:0.200~12.346,P=0.668)。结论无症状与有症状WHOⅡ级脑胶质瘤患者比较,肿瘤位于功能区的比率和术后复发率低,术后患者的生存期更长,病理学特征无明显差异。

Objective The disease characteristics and postoperative survival of asymptomatic World Health Organization(WHO)gradeⅡgliomas were analyzed.Methods The clinical data of 271 patients with WHO gradeⅡgliomas treated by neurosurgery in the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2016 were analyzed retrospectively.They were divided into the asymptomatic group(34 cases)and the symptomatic group(237 cases).The differences of disease characteristics and prognosis between the two groups were analyzed.Multivariate Cox regression was used to analyze the risk factors for prognosis.Results Compared with the symptomatic group,the proportion of tumor invading functional area in the asymptomatic group was lower[58.2%(138/237)vs.38.2%(13/34),P=0.041],but there was no significant difference between the two groups in age,gender,histological type,Ki67,mutation of isocitrate dehydrogenase(IDH)and telomerase reverse transcriptase promoter(TERTp),codeletion of 1p/19q(P>0.05).The total resection rate of tumor was 94.1%(32/34)and 78.5%(186/237)respectively.The radiotherapy rate was 97.1%(33/34)and 78.5%(186/237)respectively.The difference was statistically significant(P<0.05).All patients were followed up for 1.1-86.0 months(median:43.0 months).The recurrence rates of the asymptomatic group and the symptomatic group were 8.8%(3/34)and 27.4%(65/237)respectively.The median survival time was 45.5(28.5-80.0)months and 43.0(1.1-86.0)months respectively.The difference was statistically significant(P<0.05).Kaplan Meier survival analysis showed that the overall survival rate and progression free survival rate of asymptomatic group were significantly higher than those of symptomatic group(P<0.05).Multivariate Cox regression analysis showed that invasion of functional areas(HR=2.048,95%CI:1.017-4.125,P=0.045)and recurrence(HR=0.009,95%CI:0.002-0.038,P<0.001)were independent risk factors for postoperative survival.The presence or absence of symptoms was not an independent factor for postoperative survival(HR=1.570,95%CI:0.200~12.346,P=0.668).Conclusion Compared with patients with symptomatic low-grade gliomas,the incidence of functional area tumors and postoperative recurrence rate in asymptomatic patients were lower.There was no significant difference in pathological features,but the survival period of asymptomatic patients was longer.