偶发低级别胶质瘤的手术效果及生存预后的影响因素分析

Surgical outcomes and survival analysis of patients with incidental low-grade gliomas

目的探讨偶发低级别胶质瘤的手术效果及生存预后的影响因素。方法回顾性分析2010年1月1日至2017年12月31日手术治疗的75例成人大脑半球偶发低级别胶质瘤的临床资料。结果75例中,出现临床症状之前手术49例(无症状组),出现症状之后手术26例(症状组)。肿瘤全切除59例(78.7%),次全切除13例(17.3%),部分切除3例(4%);术后病理检查结果显示弥漫性星形细胞瘤44例(58.7%),少突胶质细胞瘤31例(41.3%)。症状组术后功能障碍发生率(11.5%,2/26)明显高于无症状组(0%;P<0.05)。59例(无症状组33例,症状组26例)术前接受MRI随访12~60个月,平均(30±10)个月;其中症状组术前随访18~60个月,平均(35±10)个月;无症状组术前随访12~38个月,平均(25±7)个月。59例肿瘤生长速率1~5 mm/年,平均(2.7±0.9)mm/年;无症状组生长速率1~5 mm/年,平均(2.9±0.9)mm/年;症状组生长速率1~4 mm/年,平均(2.5±0.7)mm/年;两组肿瘤生长速率无显著差别(P>0.05)。多因素Cox回归分析显示肿瘤切除程度、病理性质是病人总生存期(OS)、无症状生存期(PFS)及恶性进展期(MPFS)的独立影响因素,生存曲线分析显示肿瘤全切除病人的中位OS、PFS和MPFS均明显优于肿瘤未全切除病人(P<0.05),少突胶质细胞瘤病人的中位OS、PFS、MPFS均显著优于弥漫性星形细胞瘤病人(P<0.05)。结论偶发低级别胶质瘤是一类恶性度较低、呈缓慢进展的疾病。肿瘤全切除有助于改善病人的生存预后,因此,手术时机的抉择应充分考虑利于肿瘤全切除,以延长病人生存期同时兼顾功能保护的目的。

Objective To investigate the surgical outcomes and prognostic factors of patients with incidental low-grade gliomas.Methods The clinical data of 75 patients with incidental low-grade gliomas treated surgically from January 1,2010 to December 31,2017 were retrospectively analyzed.Results Of these 75 patients,49 patients received surgery before the onset of clinical symptoms(asymptomatic group),and 26 received surgery after the onset of clinical symptoms(symptomatic group).Total resection was achieved in 59 patients(78.7%),subtotal in 13(17.3%),and partial in 3(4%).Postoperative pathological examination showed diffuse astrocytoma in 44 patients(58.7%)and oligodendroglioma in 31(41.3%).The incidence of postoperative dysfunction in the symptomatic group(11.5%,2/26)was significantly higher than that(0%)in the asymptomatic group(P<0.05).Fifty-nine patients(33 patients in the asymptomatic group and 26 patients in the symptomatic group)were followed up by MRI for 12~60 months before surgery,with an average of(30±10)months.The preoperative follow-up period of the symptomatic group was 18~60 months,with an average of(35±10)months.The preoperative follow-up period of the asymptomatic group was 12~38 months,with an average of(25±7)months.The growth rate of the 59 patients was 1~5 mm/year,with an average of(2.7±0.9)mm/year.The growth rate of the asymptomatic group was 1~5 mm/year,with an average of(2.9±0.9)mm/year.The growth rate of the symptomatic group was 1~4 mm/year,with an average of(2.5±0.7)mm/year.There was no significant difference in the growth rate of the two groups(P>0.05).Multivariate Cox regression analysis showed that the extent of tumor resection and pathological nature were independent factors affecting overall survival(OS),progression-free survival(PFS)and malignant progression free survival(MPFS).Survival curve analysis showed that the median OS,PFS and MPFS of patients with total tumor resection were significantly better than those of patients with subtotal tumor resection(P<0.05),and the median OS,PFS and MPFS of patients with oligodendroglioma were significantly better than those of patients with diffuse astrocytoma(P<0.05).Conclusions Incidental low-grade gliomas is a kind of disease with low malignant degree and slow progression.Total tumor resection is helpful to improve the survival prognosis of patients.Therefore,the timing of surgery should be fully considered to be beneficial to total tumor resection,so as to prolong the survival of patients and protect function.