室管膜下区相关IDH野生型胶质母细胞瘤:MGMT甲基化特征及生存预后分析

Subventricular zone-associated IDH wild-type glioblastoma:MGMT promoter methylation feature and prognostic analysis

目的探讨室管膜下区(SVZ)相关胶质母细胞瘤(GBM)的特征表现及其对患者生存预后的影响。方法回顾性分析2016年1月—2018年12月解放军总医院神经外科收治的116例GBM患者的临床资料,并进行定期随访。从MGMT启动子甲基化和生存预后方面对SVZ相关GBM的特征表现进行分析。结果116例患者中,MRI SVZ受累组87例(75%),SVZ未受累组29例(25%)。MRI中存在SVZ受累的GBM患者表现出了更低的MGMT启动子甲基化比例(P=0.003)和更大的肿瘤最大径(P<0.001)。SVZ受累组患者的中位总生存期(OS)及无进展生存期(PFS)为12个月和7个月,而未受累组的中位OS及PFS为25个月和17个月(P<0.001)。不同SVZ受累部位患者OS(P=0.229)及PFS(P=0.808)的差异无统计学意义。多因素生存分析显示,MRI SVZ受累患者表现出了更差的OS(HR=2.509,95%CI 1.368~4.602,P=0.003)和PFS(HR=4.082,95%CI 2.245~7.422,P<0.001)。结论SVZ相关的GBM患者表现出了较低的MGMT启动子甲基化率和更大的肿瘤侵袭范围。MRI SVZ受累是一项影响IDH野生型GBM患者OS及PFS的独立危险因素。

Objective To investigate the characteristics of subventricular zone(SVZ)associated glioblastoma(GBM)and its impact on patients'survival.Methods The clinical data of 116 patients with GBM admitted to the Department of Neurosurgery of PLA General Hospital from January 2016 to December 2018 were analyzed retrospectively,and regular follow-up was conducted.The characteristics of SVZ-associated GBM were analyzed in terms of MGMT promoter methylation and survival prognosis.Results A total of 116 patients were included in this study,including 87(75%)in the SVZ involvement group and 29(25%)in the SVZ uninvolved group.GBM patients with SVZ involvement on MRI showed a lower proportion of MGMT promoter methylation(P=0.003)and larger tumor maximum diameter(P<0.001).The median overall survival and progression-free survival of patients in the SVZ involvement group were 12 months and 7 months,while the median overall survival and progression-free survival of the uninvolved group were 25 months and 17 months(P<0.001,respectively).There was no significant difference in overall survival(OS)(P=0.229)and progression-free survival(PFS)(P=0.808)between patients with different SVZ involved regions.Multivariate survival analysis indicated that patients with MRI SVZ involvement showed worse OS(HR=2.509,95%CI 1.368-4.602,P=0.003)and PFS(HR=4.082,95%CI 2.245-7.422,P<0.001).Conclusions SVZ-associated GBM patients exhibit a lower proportion of MGMT promoter methylation and larger tumor size.MRI SVZ involvement is an independent risk factor for OS and PFS in IDH wild-type GBM patients.