胶质母细胞瘤侵犯室管膜下区及脑皮质对患者复发模式及预后的影响

Effect of glioblastoma invasion into the subventricular zone andcortex on the recurrence pattern and prognosis of patients

目的 探讨胶质母细胞瘤(GBM)发生部位与复发及预后的关系,并分析影响患者预后的危险因素。方法 回顾性分析2015年1月—2021年10月于徐州医科大学附属医院进行诊治的GBM患者,收集患者临床、影像及病理等资料并进行随访。结果 共纳入94例患者,其中男性52例,女性42例。与GBM未累及室管膜下区(SVZ-)或脑皮质(CTX-)相比,肿瘤累及室管膜下区(SVZ+)或脑皮质(CTX+)显著降低患者的无进展生存期(PFS)及总生存期(OS)(P均<0.01);与手术全切或辅助化疗≥6周期相比,手术部分切除或辅助化疗<6周期患者的PFS及OS也显著降低(P均<0.01);与肿瘤直径<5 cm、单病灶复发或局部复发相比,肿瘤直径≥5 cm、多病灶复发或远处复发患者的OS显著降低(P均<0.05)。多因素Cox回归分析显示:SVZ+、CTX+、手术部分切除及辅助化疗<6周期是影响患者PFS及OS的独立危险因素。结论 GBM累及室管膜下区或脑皮质的患者更易出现早期复发,且预后更差。原发肿瘤灶大小、手术切除程度、辅助化疗周期以及肿瘤复发模式是影响患者预后的独立因素。

Objective To explore the relationship between the location of glioblastoma(GBM)and its recurrence and prognosis,and to identify the risk factors influencing patient prognosis.Methods Retrospective analysis was conducted on GBM patients who were diagnosed and treated at the Affiliated Hospital of Xuzhou Medical University from January 2015 to October 2021.Their clinical,imaging,and pathological data were collected and followed up.Results A total of 94 patients were included,including 52 men and 42 women.Compared with patients whose tumors did not involve the subventricular zone(SVZ-)or cortex(CTX-),involvement of the subventricular zone(SVZ+)or cortex(CTX+)resulted in significant reduction in progression-free survival(PFS)and overall survival(OS)(both P<0.01).Patients who underwent partial resection or received adjuvant chemotherapy for less than six cycles also showed significantly reduced PFS and OS,compared with those who underwent complete resection or received adjuvant chemotherapy for six or more cycles(both P<0.01).Patients with tumors≥5 cm in diameter,multifocal recurrence,or distant recurrence showed significantly decreased OS,compared with those with tumors<5 cm,unifocal recurrence,or local recurrence(all P<0.05).Multivariate Cox regression analysis indicated that SVZ+,CTX+,partial resection,and adjuvant chemotherapy of less than six cycles were independent risk factors affecting PFS and OS.Conclusions GBM patients with SVZ or CTX involvement are more likely to experience early recurrence,with worse prognosis.The size of primary tumor,the extent of surgical resection,the duration of adjuvant chemotherapy,and the pattern of tumor recurrence are independent factors affecting patient prognosis.