中枢神经细胞瘤预后分析

Prognosis analysis of central neurocytoma

目的探讨中枢神经细胞瘤的流行病学特点、治疗及预后。方法回顾性分析29例中枢神经细胞瘤的临床资料,经纵裂-胼胝体入路20例,经皮质造瘘入路9例。按是否全切除肿瘤分为全切除组和未全切除组。并对病人进行长期随访,绘制Kaplan-Meier生存曲线,单因素Wilcoxon分析两组病人的5年生存率差异。结果术后第2天死亡1例,考虑丘脑梗死。28例有效随访病人中全切除8例,大部分或次全切除20例;术后接受普通放疗、伽玛刀或随访观察等辅助治疗,两组间接受术后辅助治疗的差异有统计学意义(χ^(2)=15.923,P<0.001)。全切除组5年生存率100%,未全切组5年生存率90%;两组5年生存率差异无统计学意义(P=0.3770)。全切除组术后继发性感染1例,经治疗后治愈。未全切除组术后出现脑积水1例,行脑室-腹腔分流术;未全切组复发3例,再次行开颅手术1例,未接受后期治疗死亡2例。结论中枢神经细胞瘤常见于年轻病人,预后较好,手术全切除或大部分切除后辅助放疗均能获得较好预后。

Objective To investigate the epidemiology,treatment and prognosis of central neurocytoma.Methods Clinical data of 29 patients with central neurocytoma were analyzed retrospectively,and the operation was performed in 20 cases via longitudinal fissure and corpus callosum approach and 9 cases via cortical fistula approach.The patients were divided into total resection group and non-total resection group according to whether total resection or not.Long-term follow-up was conducted.Kaplan-Meier survival curve was plotted and 5-year survival rate was analyzed by univariate Wilcoxon analysis.Results One patient died of thalamic infarction on the 2nd day after surgery,and 28 patients with effective follow-up achieved total resection in 8 patients,subtotal or partial resection in 20,and received adjuvant therapy such as radiotherapy,gamma knife or follow-up observation.There was statistically significant difference in receiving adjuvant therapy after surgery between the two groups(χ^(2)=15.923,P<0.001).Five-years survival rate was 100%in the total resection group and 90%in the non-total resection group,and there was no significant difference in 5-year survival rate between the two groups(P=0.3770).Postoperative secondary infection occurred in 1 patient and was cured after treatment in the total group.Hydrocephalus occurred in 1 patient and received ventriculoperitoneal shunt,and 3 patients recurred,1 patient underwent second craniotomy and 2 died without later treatment in the non-total resection group.Conclusion Central neurocytoma is common in young patients and has a good prognosis.Total resection or partial resection with adjuvant radiotherapy has a good prognosis.