岛状胶质母细胞瘤的临床特点及预后因素

Q4 Medicine

中华神经外科杂志 Pub Date : 2020-02-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2020.02.003

Yin-yan Wang, Xing Liu, Yiming Li, Jiangfei Wang, Lei Wang, Yongheng Wang

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Furthermore, multivariate Cox regression analysis was used to investigate the prognostic clinical factors. \n \n \nResults \nIn a total of 44 patients, 33 (75.0%) had a history of epileptic seizure, 11 (25.0%) had isocitrate dehydrogenase 1 (IDH1) mutation, 19 (43.2%) had O6-methy-lguanine-DNA-methyltransferase (MGMT) methylation, and 42 (95.5%) had tumor enhancement.Based on Yasargil′s classification, there were type 3A in 2 cases, type 3B in 27 cases and type 5A/B in 15 cases. Based on Saito′s classification, there were 2 cases confined to the insular cortex, 9 cases with invasion to the frontal lobe via the anterior circumferential sulcus, 16 cases with invasion to the temporal lobe via the lower circumferential sulcus, and 17 cases with invasion to multiple directions via more than 2 circumferential sulci. Based on Moshe′s classification, there were 35 cases with envelopment or invasion of the lenticulostriate artery, while no invasion was reported in the remaining 9 cases. Based on the putamen classification, there were 38 cases with various degrees of putamen invasion, and the remaining 6 cases had no involvement of the putamen. Kaplan-Meier curve showed that the median PFS of all patients was 278 d and the median OS was 435 d. Multivariate Cox regression analysis showed that tumor volume < median (HR = 0.390, 95% CI: 0.189-0.802, P=0.011), IDH1 mutation (HR=0.391, 95% CI: 0.175-0.876, P=0.023) and postoperative radiochemotherapy (HR=0.346, 95% CI: 0.162-0.738, P=0.006) were independent protective factors for PFS. However, MGMT methylation (HR=0.371, 95% CI: 0.181-0.758, P=0.007), tumor resection degree ≥90% (HR=0.412, 95% CI: 0.194-0.875, P=0.021) and postoperative radiochemotherapy (HR=0.347, 95% CI: 0.170-0.708, P=0.004) were independent protective factors for OS. \n \n \nConclusions \nClinical characteristics of insula glioblastomas include relatively lower incidence, stronger invasiveness, lower total resection ratio and poorer prognosis. 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引用次数: 0

摘要

目的探讨岛状胶质母细胞瘤的临床特点及预后因素。方法对2006年7月至2013年6月中国胶质瘤基因组图谱（CGGA）数据库中44例岛状胶质母细胞瘤患者的临床资料进行评估。所有患者均接受了肿瘤切除术。其中27例接受了辅助放化疗，17例未接受术后辅助治疗。采用Kaplan-Meier方法分析所有患者的无进展生存期（PFS）和总生存期（OS）。此外，采用多变量Cox回归分析来研究预后的临床因素。结果44例患者中，33例（75.0%）有癫痫病史，11例（25.0%）有异柠檬酸脱氢酶1（IDH1）突变，19例（43.2%）有O6甲基胍DNA甲基转移酶（MGMT）甲基化，42例（95.5%）有肿瘤增强。根据Yasargil的分类，3A型2例，3B型27例，5A/B型15例。根据Saito分类，2例局限于岛叶皮质，9例经前周沟侵犯额叶，16例经下周沟侵犯颞叶，17例经2个以上周沟多方向侵犯。根据Moshe的分类，有35例豆纹动脉被包裹或侵犯，其余9例无侵犯报告。根据壳核分类，有38例有不同程度的壳核侵犯，其余6例没有壳核侵犯。Kaplan-Meier曲线显示，所有患者的中位PFS为278 d，中位OS为435 d。多因素Cox回归分析显示，肿瘤体积＜中位（HR=0.390，95%CI:0.189-0.802，P=0.011）、IDH1突变（HR=0.391，95%CI:0.175-0.876，P=0.023）和术后放化疗（HR=0.346，95%CI0.162-0.738，P=0.006）是PFS的独立保护因素。然而，MGMT甲基化（HR=0.371，95%CI:0.18-0.758，P=0.007）、肿瘤切除度≥90%（HR=0.412，95%CI:0.194-0.875，P=0.021）和术后放化疗（HR=0.347，95%CI0.170-0.708，P=0.004）是OS的独立保护因素。结论脑岛胶质母细胞瘤的临床特点是发病率相对较低，侵袭性较强，全切除率较低，预后较差。最大限度的切除和标准的术后放化疗可能会带来更好的结果。关键词：胶质母细胞瘤；Insula；预后；多变量分析

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Clinical characteristics and prognostic factors of insular glioblastomas

Objective To explore the clinical characteristics and prognostic factors of insular glioblastomas. Methods Clinical data of 44 patients with insular glioblastomas in Chinese Glioma Genome Atlas(CGGA) databases from July 2006 to June 2013 were evaluated. All patients underwent tumor resection. Among them, 27 underwent adjuvant radiochemotherapy and 17 underwent no postoperative adjuvant therapy. Progression-free survival (PFS) and overall survival (OS) of all patients were analyzed by Kaplan-Meier method. Furthermore, multivariate Cox regression analysis was used to investigate the prognostic clinical factors. Results In a total of 44 patients, 33 (75.0%) had a history of epileptic seizure, 11 (25.0%) had isocitrate dehydrogenase 1 (IDH1) mutation, 19 (43.2%) had O6-methy-lguanine-DNA-methyltransferase (MGMT) methylation, and 42 (95.5%) had tumor enhancement.Based on Yasargil′s classification, there were type 3A in 2 cases, type 3B in 27 cases and type 5A/B in 15 cases. Based on Saito′s classification, there were 2 cases confined to the insular cortex, 9 cases with invasion to the frontal lobe via the anterior circumferential sulcus, 16 cases with invasion to the temporal lobe via the lower circumferential sulcus, and 17 cases with invasion to multiple directions via more than 2 circumferential sulci. Based on Moshe′s classification, there were 35 cases with envelopment or invasion of the lenticulostriate artery, while no invasion was reported in the remaining 9 cases. Based on the putamen classification, there were 38 cases with various degrees of putamen invasion, and the remaining 6 cases had no involvement of the putamen. Kaplan-Meier curve showed that the median PFS of all patients was 278 d and the median OS was 435 d. Multivariate Cox regression analysis showed that tumor volume < median (HR = 0.390, 95% CI: 0.189-0.802, P=0.011), IDH1 mutation (HR=0.391, 95% CI: 0.175-0.876, P=0.023) and postoperative radiochemotherapy (HR=0.346, 95% CI: 0.162-0.738, P=0.006) were independent protective factors for PFS. However, MGMT methylation (HR=0.371, 95% CI: 0.181-0.758, P=0.007), tumor resection degree ≥90% (HR=0.412, 95% CI: 0.194-0.875, P=0.021) and postoperative radiochemotherapy (HR=0.347, 95% CI: 0.170-0.708, P=0.004) were independent protective factors for OS. Conclusions Clinical characteristics of insula glioblastomas include relatively lower incidence, stronger invasiveness, lower total resection ratio and poorer prognosis. Maximum resection and standard postoperative radiochemotherapy may lead to a better outcome. Key words: Glioblastoma; Insula; Prognosis; Multivariate analysis

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.