摘要目的 探讨脑胶质瘤的临床疗效和影响其预后的临床因素.方法 回顾性纳入2000年1月至2016年12月中山大学肿瘤防治中心神经外科行手术切除的741例原发性脑胶质瘤患者,术后行放疗、化疗或两者联合治疗.采用Kaplan-Meier生存曲线分析不同病理、术后不同治疗方式与脑胶质瘤患者生存期的关系.进一步通过单因素和多因素Cox回归分析方法评价影响高级别和低级别脑胶质瘤患者预后的临床因素.结果 741例患者中,482例(65.0％)肿瘤全切除,115例(15.5％)肿瘤次全切除,136例(18.4％)部分切除,8例(1.1％)活检.术后病理检查结果,世界卫生组织(WHO)Ⅰ级64例,Ⅱ级194例,Ⅲ级191例,Ⅳ级292例.所有患者的随访时间为1～188个月,中位时间17.0个月.随访期间314例患者死亡.WHOⅠ、Ⅱ、Ⅲ和Ⅳ级脑胶质瘤患者的中位生存期(OS)分别为未达到(＞76.0个月)、123.0(107.5 ～139.4)个月、33.0(25.5 ～40.5)个月和17.0(15.3～18.8)个月;随着病理学分级的增高,脑胶质瘤患者的生存期逐渐缩短(x2=138.200,P＜0.001).高级别胶质瘤(WHOⅢ、Ⅳ级)患者,术后放疗联合化疗组的OS[36.0(29.4 ～42.6)个月]显著长于术后放疗或化疗组[23.0(16.3 ～29.7)个月,P=0.012]和单纯手术组[10.0(9.0～11.0)个月,P＜0.001];低级别胶质瘤(WHOⅡ级)患者,术后放疗或化疗组的中位OS[未达到(＞73.0个月)]显著长于单纯手术组[54.8(24.9 ～ 84.7)个月,P=0.004)].多因素Cox回归分析显示,年龄、病理学类型、肿瘤切除程度及术后是否放疗和化疗是影响高级别胶质瘤患者的独立危险因素(均P＜0.05);而年龄、病理学类型及肿瘤切除程度是影响低级别胶质瘤患者的独立危险因素(均P＜0.05).结论 高级别胶质瘤患者术后采用放疗联合化疗的方式预后较好,低级别胶质瘤患者术后采用化疗或放疗预后较好.年龄、病理学类型及肿瘤切除程度是影响脑胶质瘤患者预后的主要危险因素.

abstractsObjective To review the treatment effect of brain gliomas and to investigate the clinical factors influencing the patients' outcomes.Methods A total of 741 patients were enrolled into this retrospective study who underwent their first operation and were diagnosed as primary brain gliomas at Neurosurgery Department of Sun Yat-sen University Cancer Center between January 2000 and December 2016.The patients were treated with various adjuvant therapies after operation.Survival difference between gliomas with varying tumor pathology and treatment methods were evaluated by Kaplan-Meier method with log-rank test.The multivariate Cox regression analysis of the clinical factors related to the patient's outcome was performed.Results A total of 741 patients with follow-up data were reviewed.Tumor total resection and subtotal resection were respectively achieved in 482 (65.0％) and 115 (15.5％) patients.Sixty-four cases were diagnosed as WHO grade Ⅰ glioma,194 as grade Ⅱ,191 as grade Ⅲ and 292 as grade Ⅳ.At a median follow-up of 17.0 months (1-188 months),314 patients were died.The median overall survival (OS) of patients with grade Ⅰ,Ⅱ,Ⅲ,Ⅳ gliomas were not reached (＞76.0months),123.0 (107.5-139.4) months,33.0 (25.5-40.5) months and 17.0 (15.3-18.8) months,respectively.The survival was decreased with the increase of pathological grades of gliomas (x2 =138.200,P ＜0.001).High-grade gliomas (grade Ⅲ and Ⅳ) treated with postoperative radiotherapy and chemotherapy had longer survival [36.0 (29.4-42.6) months] than those undergoing radiotherapy or chemotherapy only [23.0(16.3-29.7) nonths,P =0.012] and those without adjuvant treatment [10.0 (9.0-11.0) months,P ＜0.001].Low-grade gliomas (grade Ⅱf) treated with postoperative radiotherapy or chemotherapy had better prognosis [median OS:not reached (＞73.0 months)] than those undergoing surgery only [54.8 (24.9-84.7)months.P =0.004].In addition,multivariate analysis revealed that age,histology type,extent of tumor resection and postoperative radiotherapy and chemotherapy were independent factors associated with OS of high-grade gliomas (all P ＜ 0.05).For low-grade gliomas,Postoperative radiotherapy or chemotherapy could improve the survival of patients with Low-grade gliomas.age,tumor pathology and resection extent of tumor were independent prognostic factors (all P ＜ 0.05).Conclusions Postoperative radiotherapy and chemotherapy could improve the survival of patients with high-grade gliomas.Age,tumor pathology and resection extent of tumor seem to be major factors related to the clinical outcome of brain gliomas.