联合放化疗对基底节区生殖细胞肿瘤的疗效及影响因素

Therapeutic effect and influencing factors of combined radiotherapy and chemotherapy on germ cell tumors in basal ganglia

目的研究联合放化疗对基底节区生殖细胞肿瘤的疗效及影响因素。方法对2009年1月~2019年1月首诊于广东三九脑科医院肿瘤中心的52例基底节区生殖细胞肿瘤患者进行生存分析,将放化疗后存在明显残留与无明显残留的两组患者进行组间比较,以分析影响疗效的临床因素。结果至2020年6月15日,中位随访时间38月(范围13~125月),随访49例,3例失访。其中40人生存,9例死亡。3年总生存率83%,3年无进展生存率84%。6例患者在接受放化疗后存在明显残留(肿瘤稳定或进展),46例患者无明显残留(部分缓解或完全缓解)。诊断为生殖细胞瘤的患者为30例(57.7%),非生殖细胞瘤性生殖细胞肿瘤患者22例(42.3%)。非生殖细胞瘤性生殖细胞肿瘤较生殖细胞瘤更易出现治疗后残留,两组差异有统计学意义(P=0.013),伴随肿瘤标记物异常增高(甲胎蛋白>500 ng/mL或人绒毛膜促性腺激素>1000 mU/mL)患者较低危组患者更易出现治疗后残留(P=0.000)。单因素及多因素分析均发现治疗结束时是否存在肿瘤明显残留是影响生存的独立预后因素(P=0.024,HR=0.306,95%CI:0.024~1.488)。结论基底节区生殖细胞肿瘤随肿瘤类型、肿瘤标记物的不同对治疗反应不同,治疗后存在明显残留是影响生存的独立预后因素。对于明显残留的非生殖细胞瘤性生殖细胞肿瘤建议行再次手术治疗以利于局部控制。

Objective To explore the efficacy of combined radiotherapy and chemotherapy on germ cell tumors in the basal ganglia and analysis of influencing factors.Methods From January 2009 to January 2019,52 cases of germ cell tumors in the basal ganglia were first diagnosed in the Cancer Center of Guangdong Sanjiu Brain Hospital.Survival analysis was performed on the whole group of patients;the residual and non-residual after radiotherapy and chemotherapy were divided to 2 groups.The clinical factors which would affect the efficacy were analyzed between 2 groups.Results On June 15,2020,the median follow-up time was 38 months(range 13-125 months),49 cases were followed up,and 3 cases were lost.Of these,40 survived and 9 died.The 3-year overall survival rate was 83%,and the 3-year progression-free survival rate was 84%.Six patients had significant residues(tumor stability or progression)after receiving chemotherapy and radiotherapy,and 46 patients had no significant residues(partial remission or complete remission).There were 30 patients(57.7%)diagnosed with germ cell tumors,and 22 patients(42.3%)with non-germinomaus germ cell tumors.Non-germinomaus germ cell tumors were more likely to remain after treatment than germ cell tumors.There was a significant statistical difference between the two groups(P=0.013),accompanied by abnormally increased tumor markers(AFP greater than 500 ng/mL or HCG greater than 1000 mU/mL).High risk patients were more likely to have residual after treatment than the low-risk group(P=0.000).Both univariate and multivariate analysis found that the presence or absence of significant tumor residue at the end of treatment was an independent prognostic factor affecting survival,P=0.024(HR:0.306,95%CI:0.024-1.488).Conclusion Germ cell tumors in the basal ganglia have different response to treatment with different tumor types and tumor markers.Obvious residual after treatment is an independent prognostic factor affecting survival.For the obvious residual non-germinomaus germ cell tumors,surgical treatment is recommended again to facilitate local control.