摘要
目的:探讨成人初发大脑半球胶质瘤患者的预后影响因素以及手术切除程度与患者生存期、术后癫痫控制率的关系。方法:基于中国脑胶质瘤基因组图谱计划(CGGA)数据库,回顾性分析2006年1月至2018年12月首都医科大学附属北京天坛医院神经外科接受手术治疗的1828例成人初发大脑半球胶质瘤患者的临床资料,并根据世界卫生组织(WHO)2016版中枢神经系统肿瘤分类标准进行病理学分级。采用单因素和多因素Cox回归分析法分析患者生存预后的影响因素;通过Kaplan-Meier生存曲线分析比较各级别脑胶质瘤患者之间的生存期差异。结果:WHOⅢ、Ⅳ级脑胶质瘤患者的中位总生存期分别为82.43个月(2.60~164.20个月)和16.47个月(0.63~143.43个月);中位无进展生存期分别为64.73个月(0.67~156.70个月)和12.13个月(0.63~143.43个月)。WHOⅡ、Ⅲ级脑胶质瘤中,伴有异柠檬酸脱氢酶(IDH)突变和染色体1p/19q联合缺失脑胶质瘤患者的生存预后显著延长(P<0.001);WHOⅣ级脑胶质瘤中,伴有IDH突变脑胶质瘤患者的生存预后显著延长(P<0.001)。多因素Cox回归分析结果显示,年龄(HR=1.015,95%CI:1.006~1.024,P<0.001)为独立的不良预后因素;而肿瘤全切除(HR=0.220,95%CI:0.175~0.277,P<0.001)、WHO低级别(WHOⅡ级对比Ⅳ级:HR=0.142,95%CI:0.104~0.192,P<0.001;WHOⅢ级对比Ⅳ级:HR=0.348,95%CI:0.265~0.458,P<0.001)、IDH突变(HR=0.511,95%CI:0.400~0.652,P<0.001)、染色体1p/19q联合缺失(HR=0.536,95%CI:0.404~0.711,P<0.001)为独立的良好预后因素。携带IDH突变特征的脑胶质瘤更易于实现手术全切除(均P<0.05)。肿瘤全切除能够显著延长患者的总生存期及无进展生存期(均P<0.001),并且明显改善患者术后12个月的癫痫控制率(均P<0.01)。结论:患者年龄、WHO级别、肿瘤切除程度、IDH突变及染色体1p/19q联合缺失是成人初发大脑半球胶质瘤患者生存预后的影响因素。脑胶质瘤行最大范围安全切除能够延长患者的生存期,并降低术后癫痫的发生率。
Objective To explore the prognostic factors of adult cerebral glioma and the relationship between tumor resection and survival as well as postoperative seizure control rate.Methods Based on the Chinese Glioma Genome Atlas(CGGA),a total of 1828 glioma patients who underwent surgical resection at Department of Neurosurgery of Beijing Tiantan Hospital,Capital Medical University from January 2006 to December 2018 were enrolled in this retrospective study.The clinicopathological information and follow-up data of all patients were collected.All tumors were classified according to the 2016 World Health Organization(WHO)Classification of Tumors of the Central Nervous System.The prognostic factors were identified by univariate and multivariate Cox regression analysis,and the survival differences between different patient subgroups were evaluated by Kaplan-Meier analysis.Results The median overall survival periods of WHO gradeⅢandⅣglioma patients were 82.43(2.60-164.20)months and 16.47(0.63-143.43)months,respectively.The median progression-free survival periods of WHO gradeⅢandⅣglioma patients were 64.73(0.67-156.70)months and 12.13(0.63-143.43)months,respectively.For WHOⅡandⅢgliomas,the survival of patients with isocitrate dehydrogenase(IDH)mutation and chromosomal 1p/19q codeletion was significantly prolonged(P<0.001).For WHO gradeⅣgliomas,the survival of patients with IDH mutations was significantly prolonged(P<0.001).Multivariate Cox regression analysis showed that increased age(HR=1.015,95%CI:1.006-1.024,P<0.001)was an independent adverse prognostic factor;and gross total tumor resection(HR=0.220,95%CI:0.175-0.277,P<0.001),WHO lower grade(WHOⅡvs.Ⅳ:HR=0.142,95%CI:0.104-0.192,P<0.001;WHOⅢvs.Ⅳ:HR=0.348,95%CI:0.265-0.458,P<0.001),IDH mutation(HR=0.511,95%CI:0.400-0.652,P<0.001),chromosome 1p/19q codeletion(HR=0.536,95%CI:0.404-0.711,P<0.001)were independent favorable prognostic factors.IDH-mutated tumors were more amenable to surgical resection(all P<0.05).Tumor total resection could significantly prolong the overall survival and progression-free survival(all P<0.001)and improve the seizure-control rate at 12 months after surgery for patients with gradeⅡ-Ⅳgliomas(all P<0.01).Conclusions Age,WHO grade,the extent of resection,IDH mutation status,and chromosome 1p/19q co-deletion status are prognostic factors for patients with primary cerebral gliomas.Maximal safe resection of the tumor could prolong survival of patients and improve the postoperative seizure control rate.
作者
江涛
晋强
张忠
周大彪
李少武
乔慧
张伟
王引言
李冠璋
方晟宇
Jiang Tao;Jin Qiang;Zhang Zhong;Zhou Dabiao;Li Shaowu;Qiao Hui;Zhang Wei;Wang Yinyan;Li Guanzhang;Fang Shengyu(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第7期706-711,共6页
Chinese Journal of Neurosurgery
