CAJ | 학술논문

目的：探讨初诊MRI影像特征及术后放疗、化疗对大脑半球高级别胶质瘤全切术后无进展生存期（progression-free survival,PFS）的影响。方法回顾性分析4个临床中心的54例影像学确定全切除又经病理证实复发或临床随访判断为进展的高级别胶质瘤的初诊MRI影像特征（包括肿瘤最大径、瘤周水肿特征、肿瘤增强程度、坏死程度、囊性变与否及是否存在卫星灶）及术后辅助放化疗情况。单因素采用Kaplan-Meier法、多因素使用Cox比例风险模型等统计方法研究这些因素与PFS的相关性。结果单因素分析显示：年龄(P=0.009)、瘤周水肿程度(P=0.001)、肿瘤坏死程度(P<0.0001)、肿瘤强化程度(P<0.0001)、术后放疗(P=0.008)、化疗(P=0.035)与肿瘤PFS相关。多因素分析结果显示：水肿程度(P=0.019)、肿瘤坏死程度(P<0.0001)为影响肿瘤PFS的独立因素且水肿和坏死程度越轻其PFS越长、术后放疗(P=0.035)、化疗(P=0.049)也为影响肿瘤PFS的独立因素且规放化疗PFS较长。结论术前MRI影像瘤周水肿程度及肿瘤坏死程度可用于评估胶质瘤全切术后PFS，大脑半球高级别脑胶质瘤即使在影像学上全切，术后也应提倡积极、规范的放疗和化疗。
목적：탐토초진MRI영상특정급술후방료、화료대대뇌반구고급별효질류전절술후무진전생존기（progression-free survival,PFS）적영향。방법회고성분석4개림상중심적54례영상학학정전절제우경병리증실복발혹림상수방판단위진전적고급별효질류적초진MRI영상특정（포괄종류최대경、류주수종특정、종류증강정도、배사정도、낭성변여부급시부존재위성조）급술후보조방화료정황。단인소채용Kaplan-Meier법、다인소사용Cox비례풍험모형등통계방법연구저사인소여PFS적상관성。결과단인소분석현시：년령(P=0.009)、류주수종정도(P=0.001)、종류배사정도(P<0.0001)、종류강화정도(P<0.0001)、술후방료(P=0.008)、화료(P=0.035)여종류PFS상관。다인소분석결과현시：수종정도(P=0.019)、종류배사정도(P<0.0001)위영향종류PFS적독립인소차수종화배사정도월경기PFS월장、술후방료(P=0.035)、화료(P=0.049)야위영향종류PFS적독립인소차규방화료PFS교장。결론술전MRI영상류주수종정도급종류배사정도가용우평고효질류전절술후PFS，대뇌반구고급별뇌효질류즉사재영상학상전절，술후야응제창적겁、규범적방료화화료。
Objective The purpose of this study was to assess the imaging features of newly diagnosed high-grade glioma and the effect of relevant factors such as postoperative radiotherapy and chemotherapy on progression-free sur-vival (PFS) time. Methods A total of 54 patients with recurrent high-grade glioma confirmed by pathology or progressive malignant glioma proved by clinical follow-up were included in this retrospective study from 4 clinical centers. The prog-nostic factors selected included MR image features at initial diagnosis (including the maximum diameter of tumor, peritu-moral edema, degree of enhancement, degree of necrosis and presence of cystic or satellite), postoperative radiotherapy and chemotherapy. Kaplan-Meier method and Cox’s proportion-hazards model were used to analyse the factors influenc-ing the progression free survival (PFS) time. Results The univariate Kaplan-Meier analysis revealed that the degree of peritumoral edema (PTE, P=0.001), degree of necrosis (P<0.001) , degree of enhancement (P<0.001), postoperative radio-therapy (P=0.008) and chemotherapy(P=0.035) were significant factors for PFS. Cox multivariate analysis also showed that the degree of PTE(P=0.019),degree of necrosis (P<0.001) were all significantly correlated with PFS. The less edema or necrosis was associated with the longer PFS. In addition, postoperative radiotherapy (P=0.035) and chemotherapy (P=0.049) were also significantly correlated with PFS. The normative chemotherapy and radiotherapy were associated with longer PFS. Conclusions The PTE and necrosis on preoperative MR images can be used to predict the PFS of glioma af-ter total resection. Adjuvant normative chemotherapy and radiotherapy should be recommend for supratentorial high-grade glioma including those even with MRI confirmed total resection.