成人脑干胶质瘤临床特点及预后:单中心10年81例患者回顾性分析

Clinical characteristics and prognosis of adult brainstem glioma:a single-center 10-year retrospective study of 81 patients

目的分析单中心成人脑干胶质瘤(ABSG)的临床特点及影响预后的相关因素,探讨成人脑干胶质瘤最佳治疗模式。方法收集成人脑干胶质瘤患者的一般临床资料及预后相关信息,采用Kaplan-Meier方法计算总生存期(OS)、log-rank检验进行单因素分析、Cox回归模型进行多因素分析,P<0.05为差异具有统计学意义。结果最终纳入分析的成人脑干胶质瘤共81例,中位随访时间17(3~108)个月;全组患者中位OS 18个月,1、2、3、5年的总生存率分别为87.4%、75.8%、61.0%、36.5%。单因素分析显示MRI增强成像病灶强化、WHO病理分级、H3K27M表达、放疗、放疗后维持化疗与预后相关;多因素Cox回归分析显示年龄、WHO病理分级、放疗、放疗后行维持化疗为独立预后因素。结论放疗仍然是成人脑干胶质瘤主要治疗手段,可从放疗后的维持化疗中获益;年龄>40岁及WHOⅣ级为独立不良预后因素;H3K27M表达对预后影响需进一步扩大样本进行分析。

Objective To analyze the clinical characteristics and prognostic factors of single center adult brainstem glioma(ABSG),and to explore the best treatment mode.Methods The general clinical data and prognosis related information of ABSG patients were collected.The overall survival(OS)was calculated by Kaplan Meier method,the log rank test was used for univariate analysis,and the Cox regression model was used for multivariate analysis.The difference was statistically significant(P<0.05).Results A total of 81 ABSG were included in the analysis.The median follow-up time was 17(3~108)months.The median OS was 18 months,and the overall survival rates at 1,2,3 and 5 years were 87.4%,75.8%,61.0%and 36.5%respectively.Univariate analysis showed that MRI enhancement,WHO pathological gradING,H3K27M expression,radiotherapy and maintenance chemotherapy after radiotherapy were correlated with prognosis.Multivariate Cox regression analysis showed that age,WHO pathological gradING,radiotherapy and maintenance chemotherapy after radiotherapy were independent prognostic factors.Conclusions Radiotherapy is still the main treatment of ABSG,and patients can be benefit from subsequent maintenance chemotherapy.The age>40 years and WHOⅣgrade were two independent unfavorable prognostic factors.Research with expanded patient volume would help to further explore the influence of H3K27M expression on ABSG prognosis.