成人较低级别胶质瘤患者的生存预后及其影响因素分析

Survival prognosis and influencing factors of adult patients with lower-grade glioma

目的探讨成人较低级别胶质瘤(LGGs)患者的生存预后及其影响因素。方法回顾性分析2015年3月至2021年9月陆军军医大学第二附属医院神经外科收治的156例小脑幕上成人LGGs患者的临床资料。156例患者中,世界卫生组织(WHO)分级为2级109例,3级47例。比较异柠檬酸脱氢酶(IDH)突变型与野生型LGGs患者的临床特征。绘制Kaplan-Meier生存曲线,采用log-rank检验比较不同组别患者的生存预后。采用单因素和多因素Cox回归模型分析LGGs患者生存预后的独立影响因素。结果IDH突变型与野生型LGGs患者的年龄、术前存在神经功能受损症状比例的差异均有统计学意义(均P<0.05)。Kaplan-Meier生存分析结果显示,156例患者的5年总生存率为77.9%,5年无进展生存率为68.8%。单因素Cox回归模型分析显示,年龄>42岁、存在神经功能受损症状、WHO分级为3级、病理学结果为星形细胞瘤、肿瘤为次全切除、IDH野生型及Ki-67增殖指数>10%均为患者总生存期的危险因素(均P<0.05);年龄>42岁、WHO分级为3级、病理学结果为星形细胞瘤、IDH野生型及Ki-67增殖指数>10%均为患者无进展生存期的危险因素(均P<0.05)。多因素Cox回归模型分析显示,WHO分级为2级(HR=0.30,95%CI:0.09~0.94,P=0.040)、肿瘤全切除(HR=0.31,95%CI:0.12~0.79,P=0.015)、IDH突变(HR=0.24,95%CI:0.10~0.59,P=0.002)为患者总生存期的独立保护性因素,WHO分级为2级(HR=0.39,95%CI:0.19~0.82,P=0.012)为患者无进展生存期的独立保护性因素。结论肿瘤全切除、肿瘤分级较低(WHO 2级)的成人LGGs患者的生存预后良好,而IDH野生型LGGs患者的生存预后较差。

Objective To investigate the survival of adult patients with lower grade gliomas(LGGs)and its influencing factors.Methods A retrospective analysis was performed on the clinical data of 156 cases of LGGs admitted to the Department of Neurosurgery of the Second Affiliated Hospital,Army Medical University from March 2015 to September 2021.Among 156 patients,there were 109 cases of WHO grade 2 and 47 cases of WHO grade 3.The clinical characteristics were compared between patients with isocitrate dehydrogenase(IDH)-wild type glioma and patients with IDH-mutant type glioma.Kaplan-Meier curve was drawn,and the survival of the two groups was compared by log-rank test.Univariate and multivariate Cox model analysis were used to determine the independent influencing factors affecting survival.Results The age and proportion of patients having neurological deficits before surgery were significantly different between patients with IDH mutant and wild-type LGGs(both P<0.05).The Kaplan-Meier curve analysis showed that the 5-year overall survival(OS)and 5-year progression-free survival(PFS)of LGGs was 77.9%and 68.8%,respectively.Log-rank analysis showed that patients older than 42,presence of neurological deficits before surgery,WHO grade 3,astrocytoma,subtotal resection,IDH wild-type and Ki-67 proliferation index greater than 10%predicted worse OS for LGGs(all P<0.05),while>42 years old,WHO grade 3,astrocytoma,IDH wild-type and Ki-67 proliferation index greater than 10%predicted worse PFS for LGGs(all P<0.05).Multivariate Cox risk analysis showed that lower tumor grade(HR=0.30,95%CI:0.09-0.94,P=0.040),gross total resection(HR=0.31,95%CI:0.12-0.79,P=0.015),and IDH mutations(HR=0.24,95%CI:0.10-0.59,P=0.002)were independent protective factors for the OS of LGGs.Lower tumor grade(HR=0.39,95%CI:0.19-0.82,P=0.012)was independent protective factor for PFS of LGGs.Conclusion Gross total resection and lower tumor grade(WHO grade 2)are associated with good prognosis for LGGs,while IDH wild-type LGGs suggests worse prognosis.