脊髓室管膜瘤术后放射治疗的疗效及预后影响因素分析

Efficacy and prognostic factors for spinal ependymomas after postoperative radiotherapy

目的:探讨脊髓室管膜瘤术后放疗疗效及预后影响因素。方法:回顾性分析2009年1月至2018年12月首都医科大学附属北京世纪坛医院放疗科收治的经病理证实的32例脊髓室管膜瘤术后放射治疗患者的临床资料,观察疗效并进行预后影响因素分析。生存分析采用Kaplan-Meier法,单因素分析采用Log-Rank法,多因素分析采用Cox比例风险回归模型评估。结果:中位随访61.5月,11例发生术后复发,复发时间在1~80月,平均39.4月,9例为原位复发,2例发生全中枢播散。随访中,患者死亡3例,均为肿瘤相关死亡。3年、5年无进展生存(PFS)率分别为68.8%(22/32)、65.6%(21/32),3年、5年总生存(OS)率分别为93.8%(30/32)、90.6%(29/32)。手术切除程度、病理级别、放疗对无进展生存率具有显著性影响(P=0.012、P=0.004、P=0.000),全切除术组患者的总生存率明显优于次全切除术组,两组差异具有统计学意义(P=0.001)。性别、年龄、术后化疗既不影响无进展生存率,也不影响总生存率。Cox比例风险回归模型进行多因素预后分析,结果显示术后放疗影响脊髓室管膜瘤患者的无进展生存率,差异具有统计学意义(HR=0.061,95%CI:0.016~0.237,P=0.000)。结论:手术是室管膜瘤的首选治疗方法。部分切除和间变性室管膜瘤患者,术后放疗是重要的辅助治疗手段;手术切除程度、病理级别和放疗影响室管膜瘤患者预后。

Objective:To evaluate the efficacy and prognostic factors for spinal ependymomas after postoperative radiotherapy.Methods:A total of 32 patients with spinal ependymomas underwent radiotherapy after surgery in department of radiotherapy,Beijing Shijitan Hospital,Capital Medical University from January 2009 to December 2018,were analyzed retrospectively.Efficacy and related prognostic factors were observed.Kaplan-Meier method was used for survival analysis.Log-Rank test was used for univariate analysis,and Cox proportional hazards regression model was used for multivariate analysis.Results:The median survival time was 61.5 months.During the follow-up periods,11 cases(34.4%)recurrenced.Recurrence time was from 1 to 80 months,with an average of 39.4 months,including 9 cases(28.1%)with local recurrence,2 cases(6.2%)with central nervous system dissemination.During follow-up,3 patients died,all of which were tumor-related deaths.The three-year progression-free survival(PFS)rate and overall survival(OS)rate were 68.8%(22/32)and 93.8%(30/32)respectively.The five-year PFS rate and OS rate were 65.6%(21/32)and 90.6%(29/32)respectively.On univariate analysis,more favourable prognosis in terms of PFS rate was evident for gross total resection,pathological grade and radiotherapy(P=0.012,P=0.004,P=0.000).Besides,a more favourable univariate outcome in terms of OS rate was evident in patients with gross total resection(P=0.001).Gender,age,and postoperative chemotherapy did not affect PFS rate or OS rate.Multivariate analysis showed that radiotherapy was an independent prognostic factor affecting PFS rate(HR=0.061,95%CI:0.016~0.237,P=0.000),but the effect on OS rate was not statistically significant.Conclusion:Surgery is the major treatment method,while adjuvant radiotherapy is important for subtotal resection and anaplastic ependymomas patients.Surgical resection,pathological grade and radiotherapy were relevant to prognosis.