手术与放疗间隔与新发胶质母细胞瘤病人肿瘤增长及预后的相关性

Correlation between surgery and radiotherapy interval and tumor growth and prognosis in patients with new-glioblastoma

目的研究手术与放疗间隔与新发胶质母细胞瘤病人肿瘤增长及预后的相关性。方法 2013年6月~2016年8月收治的新发胶质母细胞瘤病人80例,均行手术切除治疗。按照术后放疗时间间隔不同分为<30天、30~60天、>60天3组,比较3组的各项资料,随访3年,Kaplan-Meier法分析3组病人的死亡风险。比较存活组与死亡组的临床资料,采用COX回归分析影响病人预后的独立危险因素。结果 3组病人随访期间各出现1例失访,共失访3例;<30天组3年总生存率为46.16%(12/26),中位生存时间为32(10~36)个月;30~60天组3年总生存率为48.00%(12/25),中位生存时间为32(9~36)个月;>60天组3年总生存率为42.31%(11/26),中位生存时间为30(8~36)个月;Kaplan-Meier生存曲线分析显示,3组病人3年死亡风险比较无统计学差异(Log-rankχ2=0.046,P=0.977);死亡组病人年龄、KPS评分、手术切除范围与存活组比较,差异有统计学意义(P<0.05);多因素COX回归分析显示,年龄≥65岁(HR=2.162,95%CI:1.455~4.026,P=0.001),术前KPS评分<80分(HR=1.634,95%CI:1.006~3.241,P=0.003),部分手术切除(HR=3.241,95%CI:2.343~5.862,P<0.001)是导致新发胶质母细胞瘤死亡的危险因素(P<0.05)。结论对于新发胶质母细胞瘤病人,术后放疗时间间隔对于预后并无明显影响,年龄、术前KPS评分和手术切除范围影响病人不良预后。

Objective To investigate correlation between surgery and radiotherapy interval and tumor growth and prognosis in patients with new-glioblastoma.Methods This retrospective analysis included 80 cases of new glioblastoma undergoing surgical resection from June 2013 to August 2016.They were divided into three groups,<30 days group,30-60 days group,> 60 days group,according to the postoperative radiotherapy interval.The data of the three groups were compared,and the risk of death of the three groups was analyzed by Kaplan-Meier method after 3 years of follow-up.The clinical data of the survival group and the death group were compared,and independent risk factors affecting the prognosis of the patients were analyzed using COX regression analysis.Results During the follow-up of the three groups of patients,one case was lost to follow-up and a total of 3 cases were lost to follow-up.The <30 days group’s 3-year overall survival rate was 46.16%(12/26),and its median survival time was 32(10-36) months.The 30-60 day group’s 3-year overall survival rate was 48.00%(12/25),and its median survival time was 32(9-36) months.The 3-year overall survival rate of the 60-day group was 42.31%(11/26),with a median survival time of 30(8 ~ 36) months.Kaplan-Meier survival curve analysis showed that there was no significant difference in the three-year mortality risk between the three groups of patients(log-rank χ~2 = 0.046,P= 0.977).Patients in the death group had statistically significant differences in age,KPS score,surgical resection range and survival group(P <0.05).Multivariate COX regression analysis showed that age ≥ 65 years(HR=2.162,95%CI:1.455-4.026,P=0.001),preoperative KPS score < 80 points(HR=1.634,95%CI:1.006-3.241,P=0.003),and partial surgical resection(HR=3.241,95%CI:2.343-5.862,P<0.001) were risk factors for new GBM deaths(P<0.05).Conclusion For patients with new-onset glioblastoma,the interval between postoperative and radiotherapy has no significant effect on the prognosis,but age,KPS score before surgery,and the extent of surgical resection will affect the patient’s poor prognosis.