CAJ | 학술논문

目的本研究分析初诊恶性脑胶质瘤患者接受包括手术、放疗和化疗在内的综合治疗的生存情况.方法回顾性分析2000年2月至2010年2月中山大学肿瘤防治中心神经外科/神经肿瘤科收治的经综合治疗的122例初诊恶性脑胶质瘤患者的临床资料并行生存随访.患者中位年龄40岁(5～75岁),中位卡氏体力状况评分80分(60～ 100分).综合治疗包括:尽可能保全重要神经功能的前提下最大限度手术切除肿瘤；术后2～4周开始局部常规分割外照射辅助放疗,总剂量54～60 Gy;放疗结束后2～4周开始辅助化疗4～6个疗程,采用替莫唑胺或亚硝脲类药物为主的方案,或非替莫唑胺非亚硝脲类方案.结果 70例Ⅳ级和52例Ⅲ级胶质瘤患者的中位总生存时间分别为17.0和36.0个月,2、3、4及5年总生存率分别为32.0％和64.8％、19.6％和47.8％、11.8％和32.0％、5.9％和25.4％ (P ＜0.01)；中位无进展生存时间分别为9.0和12.0个月,1、2及3年无进展生存率分别为30.8％和50.0％、12.3％和31.4％、9.2％和17.7％ (P ＜0.01).病理类型是影响总生存率及无进展生存率的独立预后因子(P＜0.01).结论包括手术、放疗和化疗在内的综合治疗可以改善恶性脑胶质瘤患者的生存.
목적 본연구분석초진악성뇌효질류환자접수포괄수술、방료화화료재내적종합치료적생존정황.방법 회고성분석2000년2월지2010년2월중산대학종류방치중심신경외과/신경종류과수치적경종합치료적122례초진악성뇌효질류환자적림상자료병행생존수방.환자중위년령40세(5～75세),중위잡씨체력상황평분80분(60～ 100분).종합치료포괄:진가능보전중요신경공능적전제하최대한도수술절제종류；술후2～4주개시국부상규분할외조사보조방료,총제량54～60 Gy;방료결속후2～4주개시보조화료4～6개료정,채용체막서알혹아초뇨류약물위주적방안,혹비체막서알비아초뇨류방안.결과 70례Ⅳ급화52례Ⅲ급효질류환자적중위총생존시간분별위17.0화36.0개월,2、3、4급5년총생존솔분별위32.0％화64.8％、19.6％화47.8％、11.8％화32.0％、5.9％화25.4％ (P ＜0.01)；중위무진전생존시간분별위9.0화12.0개월,1、2급3년무진전생존솔분별위30.8％화50.0％、12.3％화31.4％、9.2％화17.7％ (P ＜0.01).병리류형시영향총생존솔급무진전생존솔적독립예후인자(P＜0.01).결론 포괄수술、방료화화료재내적종합치료가이개선악성뇌효질류환자적생존.
Objective To explore the survival of newly diagnosed maligant gliomas patients on combined modality therapy of surgery,radiotherapy and chemotherapy.Methods The data of 122 newly diagnosed maligant glioma patients on combined modality therapy at our center between 2000 and 2010 were retrospectively reviewed and analyzed.The median age was 40 years old (range:5-75) and median Karnofsky performance status score (KPS) 80(range:60-100).Combined modality therapy consisted of surgery (maximal safety tumor resection),followed by fractionated focal irradiation for a total dose of 54-60 Gy and then 4-6 cycles of adjuvant chemotherapy including temozolomide or nitrosourea-based regimens or other ones without temozolomide and nitrosourea.The overall and progression-free survivals were analyzed by the Kaplan-Meier method and the influencing factors screened by Cox proportional hazard model.Results There were grade Ⅳ (n =70) and grade Ⅲ (n =52).The median survival periods were 17.0 months for grade Ⅳ patients and 36.0 months for grade Ⅲ ones.The 2,3,4 and 5-year survival rates were 32.0％ vs 64.8％,19.6％ vs47.8％,11.8％ vs 32.0％ and 5.9％ vs 25.4％ (P ＜0.01)for grades Ⅳ and Ⅲ patients respectively.The median progression-free survivals were 9.0 vs 12.0 months and 1,2 and 3-year progression-free survival rates 30.8％ vs 50.0％,12.3％ vs 31.4％ and 9.2％ vs 17.7％ (P ＜ 0.01)respectively.Multivariate analysis revealed that histologic type was an independent prognostic factor.Conclusion Combined modality therapy of surgery,adjuvant radiotherapy and chemotherapy may improve the survival of patients with malignant gliomas.