58例低级别脑胶质瘤术后放化疗疗效及预后相关因素分析 Analysis of the Curative Effect and Prognosis of 58 Cases of Low-Grade Gliomas Treated by Postoperative Chemo-Radiotherapy

Abstract

目的：探讨影响低级别胶质瘤长期生存的相关因素。方法：回顾分析2008年8月至2016年5月贵州医科大学附属肿瘤医院头颈肿瘤科收治的有完整病案及随访资料的58例低级别脑胶质瘤术后患者，单纯放疗14例，放疗联合替莫唑胺化疗44例。应用Kaplan-Meier法计算总生存率，Cox法多因素预后分析。结果：随访率为100.0%，随访时间满3、5年的病例数分别为50、29例。全组肿瘤患者5年总生存率为80.9%，中位生存时间为53.0个月。多因素分析显示诊断时年龄 ≤ 40岁、首发症状为癫痫、肿瘤病理亚型为少突星形、肿瘤全切除者有较好的预后。结论：诊断年龄 ≤ 40岁、首发症状为癫痫发作、肿瘤全切除者是影响低级别胶质瘤患者长期生存的有益因素。对于有高危因素或未达肿瘤全切除患者，建议术后4周内尽早开始放疗。是否联合替莫唑胺化疗仍需要扩大病例数及延长随访时间进一步研究。 Objective: To investigate the factors influencing the long-term survival of low-grade gliomas. Me-thods: We reviewed and analyzed 58 patients of low-grade glioma patients after surgery, who was admitted to Guizhou Medical University Affiliated Cancer Hospital head and neck cancer from Au-gust 2008 to May 2016. Among the patients, 14 only received radiotherapy, 44 cases received ra-diotherapy combined with temozolomide chemotherapy. Kaplan-Meier method was used to cal-culate the overall survival rate and the Cox regression model was used for multivariate prognostic analysis. Results: The follow-up rate was 100.0%, 50 patients were followed up for at least 3 year, and 29 for at least 5 years. The overall 5-year overall survival rate was 80.9%, the median survival time was 53.0 months. Multivariate analysis showed that the diagnosis of age ≤ 40 years, the first symptom of epilepsy, tumor pathologic subtypes was the less sudden star, total tumor resection has a better prognosis. Conclusions: Diagnosis of age ≤ 40 years, the first symptom of seizures, total tumor resection is the favorable prognostic factor for the long-tem survival in patients with low-grade glioma. Tumor pathological types have some reference value for the prognosis. For pa-tients with risk factors or less than complete resection of the tumor, it is recommended to start radiotherapy within 4 weeks after surgery as soon as possible. Whether combined with temozo-lomide chemotherapy needs to expand the number of cases and extend the follow-up time to study validation.