成人室管膜瘤的临床病理特征及预后因素分析

Analysis of clinicopathological characteristics and prognostic factors of adult ependymoma

目的探讨成人室管膜瘤的临床病理特征和预后的相关因素。方法回顾性分析宁波市临床病理诊断中心2011年7月1日至2020年6月1日诊断的56例成人室管膜瘤患者的临床和病理资料。采用Kaplan-Meier法分析患者的生存预后,应用单因素分析和COX回归分析探讨患者生存期的影响因素。结果 56例患者中,男26例,女30例,年龄18~76岁,平均49.3岁。肿瘤位于幕上13例,幕下12例,脊髓31例。初次手术45例获得全切除,11例行次全切除。术后接受放疗25例,化疗18例。随访3年和5年总生存率分别为87.3%和83.1%,3年和5年无进展生存率分别为62.7%和52.7%。单因素和多因素分析结果表明,肿瘤发生部位(HR=5.890,P=0.047)、Ki-67阳性指数(HR=8.576,P=0.039)、手术切除程度(HR=0.073,P=0.007)和术后放疗(HR=0.080,P=0.041)是患者总生存期的独立影响因素。结论对于成人室管膜瘤患者,肿瘤位于幕上,Ki-67指数高,预后较差;手术切除是最有效的治疗手段,肿瘤切除程度与生存期相关;术后积极放疗可以提高疗效。

Objective To investigate the clinicopathological characteristics and prognostic factors of adult ependymoma.Methods The explore and pathological data of 56 adult patients with ependymoma diagnosed by Ningbo Clinical Pathology Center from July 1, 2011 to June 1, 2020 were retrospectively analysed. Kaplan-Meier method was used to analyze the survival prognosis of patients, and univariate analysis and COX regression analysis were used to explore the influencing factors of patients’ survival. Results Among the 56 patients, 26 were males and 30 were females,aged 18-76 years, with an average age of 49.3 years. There were 13 cases of supratentorial tumors,12 cases of infratentorial tumors, and 31 cases of spinal cord tumors. Total resection was achieved in 45 cases for the first operation, and subtotal resection was performed in 11 cases. 25 cases received postoperative radiotherapy and 18 cases received chemotherapy.The 3-year and 5-year overall survival rates were 87.3% and 83.1%,respectively. The 3-year and 5-year progressionfree survival rates were 62.7% and 52.7%, respectively. The results of univariate and multivariate analysis showed that tumor site(HR=5.890,P=0.047),Ki-67 positive index(HR=8.576, P=0.039), degree of surgical resection(HR=0.073,P=0.007) and postoperative radiotherapy(HR=0.080, P=0.041) were independent factors influencing the overall survival of patients. Conclusion For adult patients with ependymoma, supratentorial tumors with a high Ki-67 index have a poor prognosis. Surgical resection is the most effective treatment, and the degree of tumor resection is related to survival.Postoperative radiotherapy can improve the efficacy.