胼胝体受侵袭的胶质母细胞瘤临床特点及预后分析

Clinical features and prognosis of corpus callosum involvement of patients with glioblastomas

目的:探讨胶质母细胞瘤合并胼胝体受侵患者的临床资料,包括手术方式、放化疗方式、病理特征及其与预后的相关性。方法:回顾性分析2013年4月至2018年1月就诊我科接受放化疗的胶质母细胞瘤合并胼胝体受侵患者84例,总结其自就诊开始至全部治疗结束的相关临床资料和随访结果,比较所有患者疾病相关临床资料、手术方式、放化疗方式、病理特征,分析生存情况,进而得出与该类患者预后的相关因素。结果:84例患者中,主要临床表现为头痛头晕者49例(58.3%),肿瘤好发部位主要位于额叶者36例(42.9%),其中有瘤卒中者占7例(8.3%)。84例患者中随访资料完整者70例(83.3%)。经单因素分析结果表明:手术近全切除者、Ki-67指数≤10%、IDH-1突变者预后较好(P<0.01),而肿瘤侵及胼胝体的具体部位与预后无明显相关性(P> 0.05)。Cox回归模型表明,手术近全切及IDH-1突变是胶质母细胞瘤合并胼胝体受侵患者的独立预后因素(P<0.01)。至随访结束,70例患者的中位生存期为15.7个月,1年、2年、3年、5年总生存率分别为67.1%、19.3%、8.1%、5.4%。结论:手术近全切除及IDH-1突变是胶质母细胞瘤合并胼胝体受侵患者的独立预后因素,而胼胝体具体受侵部位与预后无明显相关性。胼胝体受侵的胶质母细胞瘤患者预后较差。

Objective:To investigate the clinical data of patients with glioblastoma and corpus callosum invasion,including surgical methods,chemoradiotherapy,pathological features and their correlation with prognosis.Methods:The clinical data and follow-up results of corpus callosum involvement of 84 patients with glioblastomas who received radiotherapy in the radiotherapy department of our hospital from April 2013 to January 2018 were retrospectively analyzed.Prognostic factors were compared and analyzed.Results:Among the 84 patients,The main clinical manifestations were headache and dizziness in 49 cases(58.3%),tumor mainly located in frontal lobe in 36 cases(42.9%),among which had tumor stroke 7 cases(8.3%).Of the 84 patients,70(83.3%)patients had complete follow-up data.The single factor analysis showed that near-total resection,Ki-67 index≤10%,and IDH-1 positive patients had better prognosis(P<0.01).The specific site of tumor invasion had no significant correlation with prognosis(P>0.05).Cox regression model showed that near-total resection and IDH-1 mutation were independent prognostic factors in patients with glioblastoma with corpus callosum invasion(P<0.01).The median overall survival time of 70 patients was 15.7 months.The 1-year,2-year,3-year,and 5-year survival rates were 67.1%,19.3%,8.1%and 5.4%.Conclusion:The near-total resection and IDH-1 mutation were independent prognostic factors in patients with glioblastoma complicated with corpus callosum invasion.Patients with glioblastoma invaded by corpus callosum have a poor prognosis.