颞叶孤立性胶质母细胞瘤的手术治疗分析

Surgical outcomes of patients with isolated temporal glioblastoma

目的 探讨颞叶孤立性胶质母细胞瘤的手术方法及疗效。方法 回顾性分析2016年7月至2020年5月手术治疗的38例颞叶孤立性胶质母细胞瘤的临床资料。接受肿瘤全切除+前颞叶切除术(ALT)治疗14例(ALT组),行常规颞叶肿瘤全切除术治疗24例(常规组)。术后随访6~28个月,中位数15个月;术后3、12个月采用KPS评分评估神经功能状态,其中KPS评分≥70分为预后良好;根据RANO标准评估肿瘤进展,国际抗癫痫联盟分级1级定义为癫痫完全控制;记录总生存期(OS)和无进展生存期(PFS)。结果 ALT组术后脑室开放率(100%,14/14)明显高于常规组(33.3%,8/24;P<0.001)。ALT组与常规组术后1年癫痫完全控制率(64.3%vs.66.7%)、术后肿瘤进展率(78.5%vs.70.8%)、术后3个月预后良好率(92.9%vs.66.7%)均无统计学差异(P>0.05)。ALT组术后1年预后良好率(78.6%,11/14)明显高于常规组(41.7%,10/24;P<0.05)。ALT组中位PFS和中位OS较常规组均明显延长(P<0.05)。多因素Cox比例回归风险模型分析显示,ALT是延长PFS(OR=7.3;95%CI 1.105~47.422;P=0.037)和OS(OR=7.8;95%CI 1.117~55.183;P=0.041)的独立预测因子。结论 对于颞叶孤立性胶质母细胞瘤,在全切除肿瘤基础上,进行ALT,可明显改善病人预后。

Objective To investigate the methods and outcomes of microsurgery for the patients with isolated temporal glioblastoma.Methods The clinical of 38 patients with isolated temporal glioblastoma who underwent micorsurgery from July 2016 to May 2020 were analyzed retrospectively.Fourteen patients were treated with total tumor resection and anterior temporal lobectomy(ALT group) and 24 patients were treated with conventional total resection of temporal lobe tumors(conventional group).Postoperative followup ranged from 6 months to 28 months,with a median of 15 months.The KPS score was used to assess the neurological status 3 and 12months after surgery,and the KPS score ≥70 points was classified as good prognosis.Tumor progression was assessed according to the RANO criteria,and the International League Against Epilepsy Classification Level 1 was defined as complete control of epilepsy.Overall survival(OS) and progression-free survival(PFS) were recorded.Results The postoperative ventricle opening rate of ALT group(100%,14/14) was significantly higher than conventional group(33.3%,8/24;P0.05).The good prognosis rate of ALT group(78.6%,11/14) was significantly higher than that(41.7%,10/24) of the conventional group 1 year after operation(P<0.05).The median PFS and median OS of ALT group were significantly longer than those of conventional group(P<0.05).Multivariate Cox proportional regression hazard model analysis showed that ALT was an independent predictor for longer PFS(OR=7.3;95% CI 1.105~47.422;P=0.037) and OS(OR=7.8;95% CI 1.117~55.183;P=0.041).Conclusions ALT can significantly improve the prognosis of patients with isolated temporal glioblastoma on the basis of total tumor resection.