多模态精准手术在老年胶质母细胞瘤治疗中的应用价值

Applied value of multimodal precision surgery in treatment of glioblastoma in elderly

目的探讨老年胶质母细胞瘤(GBM)患者以手术为主的综合治疗的生存情况和预后相关因素,以及多模态精准手术在老年GBM治疗中的应用价值。方法回顾性分析河南省人民医院神经外科2013年1月—2018年9月手术治疗的102例老年GBM患者的临床资料。以性别、年龄等17个可能影响因素作为观察指标,通过Kaplan-Meier单因素分析法和Cox回归模型分析筛选出影响老年GBM患者手术治疗预后的因素。根据患者的手术方式分为多模态精准手术组和常规手术组,比较两组患者的手术肿瘤切除程度、术后Karnofsky功能状态(KPS)评分及住院时间。结果本组患者至术后末次随访的中位总生存时间(overau survival,OS)为11.71个月。单因素分析结果显示:年龄、术前癫痫、KPS评分、肿瘤大小、多模态精准手术、手术切除程度、放化疗及同步放化疗是影响老年GBM患者生存期的因素。多因素Cox回归模型分析显示:患者的年龄(P<0.001)、术前KPS评分(P=0.002)、肿瘤切除程度(P<0.001)、放化疗(P<0.001)、同步放化疗(P=0.046)均为影响预后的独立因素。多模态精准手术组的全切率(73.7%)及术后KSP评分(73.7%)均显著高于常规手术组(37.3%和45.8%);并且比常规手术组明显缩短了住院时间(P<0.05)。MGMT甲基化的患者中,替莫唑胺单药化疗组与同步放化疗组的中位OS比较,差异无统计学意义(P>0.05)。结论术前KPS评分>60分的老年GBM患者接受最大范围的手术切除肿瘤,并术后行短程低频放疗及替莫唑胺化疗等综合治疗,可获得较长的生存期。多模态精准手术可显著提高老年GBM患者的肿瘤切除程度,改善其术后生活质量,缩短住院时间。对于MGMT甲基化的老年GBM患者术后应尽早使用替莫唑胺化疗。

Objective To investigate the postoperative survival and prognostic factors of aged patients with glioblastoma multiform(GBM)treated mainly by surgery and the applied value of multimodal precision surgery in the treatment of glioblastoma in the elderly.Methods The clinical data of elderly glioblastoma patients hospitalized in Department of Neurosurgery,Henan People's Hospital from January 2013 to September 2018 were analyzed retrospectively.With 17 possible influencing factors such as gender and age as observation indexes,the influencing factors of surgical treatment related prognosis of elderly glioblastoma patients were screened by Kaplan Meier single factor analysis and Cox regression model analysis.According to the application of multimodal precision surgery in operation,the patients were divided into multimodal precision surgery group and conventional surgery group.The extent of resection,postoperative Karnofsky(KPS)and length of stay were compared between the two groups.Results The median overall survival time(OS)was 11.71 months.Single factor analysis showed that age,preoperative epilepsy,functional status score(KPS),tumor size,multimodal precision surgery,extent of surgical resection,radiotherapy and chemotherapy,and concurrent radiotherapy and chemotherapy were the factors affecting the survival of elderly GBM patients.Multivariate Cox regression model analysis showed that:patients age(P<0.001),preoperative KPS(P=0.002),surgical resection extent(P<0.001),radiotherapy and chemotherapy(P<0.001),synchronous radiotherapy and chemotherapy(P=0.046)were independent factors affecting the prognosis of elderly patients with GBM.The total resection rate(73.7%)and the postoperative KSP score(73.7%)of the multimodal precision operation group were significantly higher than those of the conventional operation group(37.3%)and the postoperative KSP score(45.8%),and the hospital stay was shortened,with statistical significance(P<0.05).For MGMT methylated elderly GBM patients,the median OS of temozolomide single drug chemotherapy group was similar to that of concurrent radiotherapy and chemotherapy group,with no statistical significance(P>0.05).Conclusions For the elderly glioblastoma patients whose KPS score is more than 60 before operation,long survival period can still be achieved after the largest range of surgical resection,short-term low-frequency radiotherapy and temozolomide chemotherapy.Multimodal precision surgery can significantly improve the resection extent of glioblastoma in the elderly,improve the quality of life of patients after surgery,and shorten the length of stay.Temozolomide should be used as early as possible in the treatment of GBM patients with MGMT methylation.