CAJ | 학술논문

目的探讨与大脑半球恶性胶质瘤生存预后相关的临床因素. 方法选择中山大学附属第一医院神经外科自2004年1月至2009年12月收治的194例恶性胶质瘤患者,其中间变性星形细胞瘤120例,胶质母细胞瘤74例,随访其生存状况,Kaplan-Meier生存分析与Cox多元同归分析患者无进展生存时间与总生存时间的影响因素. 结果间变性星形细胞瘤和胶质母细胞瘤患者的无进展生存时间分别为18、10个月,总生存时间分别为21、12个月；Kaplan-Meier生存分析法显示年轻、KPS评分高、肿瘤无强化、术前有抽搐症状及间变性星形细胞瘤患者无进展生存时间及总生存时间均较长,差异有统计学意义(P＜0.05); Cox多元回归分析显示患者年龄、KPS评分、有无抽搐、病理分级是无进展生存时间、总生存时间的影响因素,年轻、KPS评分较高、有抽搐症状、间变性星形细胞瘤患者无进展生存时间与总生存时间较长. 结论年龄较小、高KPS评分、间变性星形细胞瘤及术前有抽搐症状被提示是恶性胶质瘤患者获得较长生存期的保护因素,而性别、肿瘤部位、大小和手术切除程度对预后无影响,肿瘤强化与预后的关系有待进一步研究证实.
목적 탐토여대뇌반구악성효질류생존예후상관적림상인소. 방법 선택중산대학부속제일의원신경외과자2004년1월지2009년12월수치적194례악성효질류환자,기중간변성성형세포류120례,효질모세포류74례,수방기생존상황,Kaplan-Meier생존분석여Cox다원동귀분석환자무진전생존시간여총생존시간적영향인소. 결과 간변성성형세포류화효질모세포류환자적무진전생존시간분별위18、10개월,총생존시간분별위21、12개월；Kaplan-Meier생존분석법현시년경、KPS평분고、종류무강화、술전유추휵증상급간변성성형세포류환자무진전생존시간급총생존시간균교장,차이유통계학의의(P＜0.05); Cox다원회귀분석현시환자년령、KPS평분、유무추휵、병리분급시무진전생존시간、총생존시간적영향인소,년경、KPS평분교고、유추휵증상、간변성성형세포류환자무진전생존시간여총생존시간교장. 결론 년령교소、고KPS평분、간변성성형세포류급술전유추휵증상피제시시악성효질류환자획득교장생존기적보호인소,이성별、종류부위、대소화수술절제정도대예후무영향,종류강화여예후적관계유대진일보연구증실.
Objective To investigate the clinical factors influencing survival prognosis in patients with supratentorial malignant glioma (MG). Methods A total of 194 patients with MG,admitted to our hospital from January 2004 to December 2009, were chosen in our study; anaplastic astrocytoma (AA) was noted in 120 patients and glioblastoma multiforme (GB) was noted in 74 patients.Their survival status was followed-up.Survival related statistics were calculated using the Kaplan-Meier method,and differences between survival curves were analyzed by the log-rank test.The interaction of each prognostic factor and their effect on overall survival (OS) and progression-free survival (PFS) were analyzed with the Cox proportional hazards model. Results The median PFS and OS in AA patients were 18 and 21 months,and those in GB patients were 10 and 12 months.When PFS and OS were used as endpoints,AA patients lived longer than GB ones, while patients ≤ 40 years old lived longer than those ＞40 years old; patients with Karnofsky performance status (KPS) scored 80-100 had longer survival than those with KPS scored 60-70; patients with preoperative seizure enjoyed the same situation as compared with those without preoperative seizure. Both univariate and multivariate Cox analyses confirmed that independent influencing factors were age,KPS scores,grade of pathology and appearance of preoperative seizure; patients with young age, high KPS scores, low grade of pathology and preoperative seizure had longer PFS and OS than those without. Conclusion Young age,high KPS scores,low grade of pathology and preoperative seizure are protective prognostic factors in patients with MG,while gender,tumor size,tumor location,and extent of resection have no prognostic significance; the prognostic significance of contrast - enhancing is uncertain.