星形细胞瘤术后放疗疗效与预后因素分析

Postoperative Radiotherapy and Prognosis of Astrocytoma Patients

目的:总结星形细胞瘤术后放疗疗效,研究影响疗效的预后因素。方法:1978年至1999年共收治资料完整的星形细胞瘤272例,其中男167例,女105例;中位年龄38岁;肿瘤体积中位数80cm3。病理分级Ⅰ级73例,Ⅱ级120例,Ⅲ级60例,Ⅳ级19例。肿瘤全部切除161例,次全切除61例,部分切除50例。术后放疗应用6Mv-X线或60Co外照射,中位剂量50Gy。使用SPSS8.0软件包进行统计学分析,研究性别等9个因素与预后的关系。应用寿命表法统计生存率并绘制曲线,Kaplan-Meier法进行预后单因素分析,Cox模型进行预后多因素回归分析。结果:Ⅰ级星形细胞瘤1、3、5年生存率分别为98.6%、91.4%、73.4%,Ⅱ级1、3、5年生存率分别为88.2%、72.6%、61.5%,Ⅲ级1、3、5年生存率分别为61.7%、36.9%、26.9%,Ⅳ级1、3、5年生存率分别为40.5%、25.7%、12.9%。单因素分析:年龄、病理分级、肿瘤体积、肿瘤位置、手术方式等因素与预后密切相关。多因素分析:年龄、病理分级、手术方式、肿瘤体积等4个因素具有独立的预后意义。结论:星形细胞瘤术后应辅助放疗,年龄、病理分级、手术方式、肿瘤体积是其独立的预后因素,是制定综合治疗计划时应重点考虑的内容。

Objective:To analyze the re su lts of postoperative radiotherapy and to identify the prognostic factors.Method s:From1978to1999,272astrocytoma patients were studied ret-rospect ively.Of these patients,73had gradeⅠ,120had gradeⅡ,60had gradeⅢ, 19had gradeⅣ;161had received grossly total resection,61had subtotal re section and50had partial resection.All patients received external-beam radio therapy with6MV-X ray or 60 Co performed using Kaplan-Meier method and the mul-tivariate analysis was p erformed using Cox proportional hazard model.Results:The1-,3-,and5-yea r cumulative survival rates were98.6%,91.4%and73.4%for gradeⅠpa tients;88.2%,72.6%and61.5%for gradeⅡpatients;61.7%,36 .9%and26.9%for gradeⅢpatients;40.5%,25.7%and12.9%for g radeⅣpatients.The univariate analysis revealed a significant relationship be-tween age,pathology,tumor size,tumor location,surgical mode and survival r ate.The multivariate analysis showed that age,pathology,tumor size and surgic al mode were independent prognostic fac-tors of postoperative radiotherapy.Co nclusion:The study suggests that age,pathology,tumor size,tumor location,su rgical mode are related to survival of postoperative radiotherapy and should be considered before a astrocytoma patients received radiotherapy.