中国医药
中國醫藥
중국의약
CHINA MEDICINE
2015年
1期
41-45
,共5页
胶质母细胞瘤%预后%热量限制%心理引导%高压氧
膠質母細胞瘤%預後%熱量限製%心理引導%高壓氧
효질모세포류%예후%열량한제%심리인도%고압양
Glioblastoma%Prognosis%Caloric restriction%Psychotherapy%Hyperbaric oxygenation
目的 探讨热量限制联合心理引导及高压氧治疗对胶质母细胞瘤(GBM)全切术后患者预后的影响.方法 将45例行GBM全切术患者分为试验组(15例)和对照组(30例),手术时间为2007年11月至2011年5月,术后均经普通放疗+化疗(替莫唑胺150 mg/m2,5/28 d方案,即第1～5天用化疗药,第6 ～ 28天休息).试验组行热量限制联合心理引导及高压氧治疗,其中2例血管内皮生长因子(VEGF)++患者加行贝伐珠单抗治疗(5 mg/kg,2周1次,连续4次),1例第2次手术术中应用卡莫司汀贴片.对照组患者自行设计饮食,不进行心理引导,行放疗+化疗(方案同试验组),其中3例VEGF++患者加行贝伐珠单抗治疗(方案同试验组),2例第2次手术术中应用卡莫司汀贴片.比较2组患者生存时间,分析患者年龄、性别、肿瘤体积、肿瘤累及脑叶数量、肿瘤位于优势半球与否、手术次数、67蛋白标记指数(Ki-67)、6-氧-甲基鸟嘌呤DNA甲基转移酶(MGMT)、VEGF阳性率、卡莫司汀贴片、贝伐珠单抗与GBM患者预后的相关性.结果 与对照组比较,试验组生存期延长,差异有统计学意义[(35±13)个月比(19±11)个月,P =0.000].热量限制联合心理引导及高压氧治疗和手术次数与患者生存期呈正相关(r=0.559,P=0.000;r =0.313,P=0.036);肿瘤体积与生存期呈负相关(r=-0.436,P=0.003);Ki67、MGMT、VEGF的阳性率与患者生存期呈负相关(r=-0.497,P=0.001;r=-0.377,P=0.011;r=-0.540,P=0.000);患者年龄、性别、肿瘤累及脑叶数量及肿瘤是否位于优势半球与生存期无相关性(r=0.166,P=0.276,r=0.134,P=0.380;r =0.005,P=0.972;r =0.018,P=0.908);术中应用卡莫司汀贴片和术后应用贝伐珠单抗并不能延长患者生存期(r =0.144,P=0.345;r =0.098,P=0.522).结论 热量限制联合心理引导及高压氧治疗可以明显延长GBM患者的生存期;肿瘤体积越大、患者生存期越短;手术次数越多,患者生存期越长;MGMT、Ki-67、VEGF阳性率越低,患者生存期越长;累及脑叶数量、年龄、性别对生存期无明显影响;术中应用卡莫司汀贴片和术后应用贝伐珠单抗不能延长GBM患者生存期.
目的 探討熱量限製聯閤心理引導及高壓氧治療對膠質母細胞瘤(GBM)全切術後患者預後的影響.方法 將45例行GBM全切術患者分為試驗組(15例)和對照組(30例),手術時間為2007年11月至2011年5月,術後均經普通放療+化療(替莫唑胺150 mg/m2,5/28 d方案,即第1～5天用化療藥,第6 ～ 28天休息).試驗組行熱量限製聯閤心理引導及高壓氧治療,其中2例血管內皮生長因子(VEGF)++患者加行貝伐珠單抗治療(5 mg/kg,2週1次,連續4次),1例第2次手術術中應用卡莫司汀貼片.對照組患者自行設計飲食,不進行心理引導,行放療+化療(方案同試驗組),其中3例VEGF++患者加行貝伐珠單抗治療(方案同試驗組),2例第2次手術術中應用卡莫司汀貼片.比較2組患者生存時間,分析患者年齡、性彆、腫瘤體積、腫瘤纍及腦葉數量、腫瘤位于優勢半毬與否、手術次數、67蛋白標記指數(Ki-67)、6-氧-甲基鳥嘌呤DNA甲基轉移酶(MGMT)、VEGF暘性率、卡莫司汀貼片、貝伐珠單抗與GBM患者預後的相關性.結果 與對照組比較,試驗組生存期延長,差異有統計學意義[(35±13)箇月比(19±11)箇月,P =0.000].熱量限製聯閤心理引導及高壓氧治療和手術次數與患者生存期呈正相關(r=0.559,P=0.000;r =0.313,P=0.036);腫瘤體積與生存期呈負相關(r=-0.436,P=0.003);Ki67、MGMT、VEGF的暘性率與患者生存期呈負相關(r=-0.497,P=0.001;r=-0.377,P=0.011;r=-0.540,P=0.000);患者年齡、性彆、腫瘤纍及腦葉數量及腫瘤是否位于優勢半毬與生存期無相關性(r=0.166,P=0.276,r=0.134,P=0.380;r =0.005,P=0.972;r =0.018,P=0.908);術中應用卡莫司汀貼片和術後應用貝伐珠單抗併不能延長患者生存期(r =0.144,P=0.345;r =0.098,P=0.522).結論 熱量限製聯閤心理引導及高壓氧治療可以明顯延長GBM患者的生存期;腫瘤體積越大、患者生存期越短;手術次數越多,患者生存期越長;MGMT、Ki-67、VEGF暘性率越低,患者生存期越長;纍及腦葉數量、年齡、性彆對生存期無明顯影響;術中應用卡莫司汀貼片和術後應用貝伐珠單抗不能延長GBM患者生存期.
목적 탐토열량한제연합심리인도급고압양치료대효질모세포류(GBM)전절술후환자예후적영향.방법 장45례행GBM전절술환자분위시험조(15례)화대조조(30례),수술시간위2007년11월지2011년5월,술후균경보통방료+화료(체막서알150 mg/m2,5/28 d방안,즉제1～5천용화료약,제6 ～ 28천휴식).시험조행열량한제연합심리인도급고압양치료,기중2례혈관내피생장인자(VEGF)++환자가행패벌주단항치료(5 mg/kg,2주1차,련속4차),1례제2차수술술중응용잡막사정첩편.대조조환자자행설계음식,불진행심리인도,행방료+화료(방안동시험조),기중3례VEGF++환자가행패벌주단항치료(방안동시험조),2례제2차수술술중응용잡막사정첩편.비교2조환자생존시간,분석환자년령、성별、종류체적、종류루급뇌협수량、종류위우우세반구여부、수술차수、67단백표기지수(Ki-67)、6-양-갑기조표령DNA갑기전이매(MGMT)、VEGF양성솔、잡막사정첩편、패벌주단항여GBM환자예후적상관성.결과 여대조조비교,시험조생존기연장,차이유통계학의의[(35±13)개월비(19±11)개월,P =0.000].열량한제연합심리인도급고압양치료화수술차수여환자생존기정정상관(r=0.559,P=0.000;r =0.313,P=0.036);종류체적여생존기정부상관(r=-0.436,P=0.003);Ki67、MGMT、VEGF적양성솔여환자생존기정부상관(r=-0.497,P=0.001;r=-0.377,P=0.011;r=-0.540,P=0.000);환자년령、성별、종류루급뇌협수량급종류시부위우우세반구여생존기무상관성(r=0.166,P=0.276,r=0.134,P=0.380;r =0.005,P=0.972;r =0.018,P=0.908);술중응용잡막사정첩편화술후응용패벌주단항병불능연장환자생존기(r =0.144,P=0.345;r =0.098,P=0.522).결론 열량한제연합심리인도급고압양치료가이명현연장GBM환자적생존기;종류체적월대、환자생존기월단;수술차수월다,환자생존기월장;MGMT、Ki-67、VEGF양성솔월저,환자생존기월장;루급뇌협수량、년령、성별대생존기무명현영향;술중응용잡막사정첩편화술후응용패벌주단항불능연장GBM환자생존기.
Objective To investigated prognosis of caloric restriction combined with psychotherapy and hybaroxia chemotherapy in patients suffered by intracranial glioblastoma multiforme(GBM) under total resection.Methods Forty-five GBM patients from November 2007 to May 2011 were devided into control group(30cases) and test group(15cases).patients in underwent total resections,radiotherapies and chemotherapies (Temozolomide 150 mg/m2,5/28 day).Three VEGF positive patients were given Bevacizumab(5 mg/kg,once every two weeks,total 4 times),and two were given carmustine wafers covered on the bed of the tumor during the second surgery.Fifteen patients in were furthermore treated by caloric restriction combined with psychotherapy and chemotherapy (Temozolomide 150 mg/m2,5/28 day) associated by hybaroxia(CRPH).Two VEGF positive patients were given Bevacizumab(5 mg/kg,once every two weeks,total 4 times),and one was given carmustine wafers covered on the bed of the tumor during the second surgery.the influence of correlation factors on prognosis were analyzed.Results Overall survival were longer in control group than in test group [(35 ± 13)months vs(19 ± 11)months,P =0.000] ; caloric restriction combined with psychotherapy and hybaroxia chemotherapy werepositively correlated with operations and overall survival (r =0.559,P =0.000 ; r =0.313,P =0.036) ; survival were Negatively correlated with tumor size (r=-0.436,P =0.003) ;Ki-67 、MGMT、VEGFpositive rates were Negatively correlated with survival (r =-0.497、P =0.001 ; r =-0.377,P =0.011 ; r =-0.540,P =0.000) ; there were no association between age,sex,Tumor involving the number of lobes,tumor located in advantage hemisphere and survival(r =0.166,P =0.276,r =0.134,P =0.380 ; r =0.005,P =0.972 ; r =0.018,P =0.908) ; Carmustine wafers during surgery and Bevacizumab after surgery not prolonged survival in GBM patients (r =0.144,P =0.345 ; r =0.098,P =0.522).Conclusion CRPH can apparently prolong the life span of the patients suffered by glioblastoma multiforme.The larger the volume of tumor,the shorter GBM patient survive.The more positive MGMT and the less positive Ki-67 and VEGF,the longer GBM patient survive.Age,sex,the number of lobe tumor occupied and dominant hemisphere or not tumor occupied were seemed irrelevant variable to the prognosis of GBM.Carmustine wafers and Bevacizumab seemed cannot prolong the life span of GBM patients.
