原发性脊髓胶质母细胞瘤的临床特点及预后分析

Clinical characteristics and prognosis of primary spinal cord glioblastomas

目的探讨原发性脊髓胶质母细胞瘤(GBM)的临床特征、治疗方案及相关预后因素.方法回顾性分析2015年5月至2019年7月清华大学附属北京清华长庚医院神经外科收治的原发性脊髓GBM患者的临床资料,占同期收治的脊髓胶质瘤患者的3.6%(11/308).所有患者均接受手术治疗,2例术后接受放、化疗,3例仅行化疗,6例未接受放化疗,2例患者术后肿瘤复发后接受贝伐珠单抗挽救性治疗.术后均予临床随访.通过Kaplan-Meier分析明确患者的生存期,组间比较采用log-rank检验,以探讨可能影响原发性脊髓GBM患者生存期的临床因素.结果11例患者中,肿瘤近全切除8例,部分切除3例.11例患者术后随访1-33个月,中位随访时间为13.2个月.至末次随访,10例患者死亡,1例存活.11例患者的中位无进展生存期和中位总生存期分别为6个月和12个月.单因素log-rank分析显示,病程和肿瘤累及脊髓节段数量均可能影响原发性脊髓GBM患者的无进展生存期和总生存期(均P<0.05);此外,年龄可能影响患者的无进展生存期(P=0.049),Ki-67增殖指数可能影响患者的总生存期(P=0.043).结论原发性脊髓GBM较为罕见,预后极差.早期手术减压并联合放化疗、贝伐珠单抗等辅助治疗为其治疗方式.患者的生存期短,且病程短、肿瘤累及脊髓节段数量多、Ki-67增殖指数高以及年轻患者的预后不佳.

Objective To investigate the clinical characteristics,treatment and prognostic factors of primary spinal cord glioblastomas(GBMs).Methods The clinical data of patients with primary spinal cord GBMs admitted to the Department of Neurosurgery,Beijing Tsinghua Chang Gung Hospital from May 2015 to July 2019 were analyzed retrospectively,which accounted for 3.6%(11/308)of spinal cord tumors during the same period at our hospital.All patients received surgery,2 patients received postoperative radiotherapy and chemotherapy,3 patients received chemotherapy only,6 patients did not receive adjuvant therapy,and 2 patients received bevacizumab salvage therapy after tumor recurrence.Clinical follow-up was performed after surgery.Kaplan-Meier analysis was used to evaluate the survival of patients,and the logrank test was used to compare the groups to explore the influencing factors of the survival of patients with primary spinal cord GBMs.Results Among the 1l patients,subtotal resection was achieved in 8 patients and partial resection in 3 patients.After a median follow-up of 13.2 months(range:1-33 months),10 patients died and 1 patient survived.The median progression-free survival(PFS)and overall survival(OS)were 6.0 months and 12.0 months,respectively.Log-rank univariate analysis showed that duration of the preoperative symptoms and the number of spinal segments involved by tumor were both confirmed as factors that may influence PFS and OS(all P<0.05).Moreover,the age at diagnosis may affect PFS(P=0.049)and Ki-67 index may affect OS(P=0.043).ConclusionsPrimary spinal cord CBMs are extremely rare with malignant features and dismal prognosis.Early surgical decompression combined with adjuvant therapy such as radiotherapy and chemotherapy and bevacizumab is the treatment strategy.The survival time of primary spinal cord GBM patients is short.Short disease duration,high number of tumor segments,high Ki-67 proliferation index,and young age suggest a poor prognosis for patients.