【摘要】：研究背景與目的：神經(jīng)膠質(zhì)瘤源于神經(jīng)外胚層的腫瘤，是顱內(nèi)常見惡性腫瘤，雖然膠質(zhì)瘤發(fā)病率僅在全身腫瘤的2%，但因其生物學(xué)行為多呈浸潤(rùn)性生長(zhǎng)，由于手術(shù)難以徹底切除造成復(fù)發(fā)率高，術(shù)后腫瘤細(xì)胞耐藥性強(qiáng)，且放療后可能加重癥狀，都嚴(yán)重影響患者的術(shù)后生存時(shí)間與質(zhì)量，導(dǎo)致患者出現(xiàn)嚴(yán)重的殘疾乃至死亡，本研究亦在探討影響膠質(zhì)瘤病人術(shù)后生存規(guī)律、時(shí)間的相關(guān)因素，了解各因素間有無(wú)相應(yīng)關(guān)系，為臨床治療膠質(zhì)瘤及判斷膠質(zhì)瘤患者預(yù)后提供參考。 研究方法：選取2008年1月~2010-12月安徽醫(yī)科大學(xué)第一附屬醫(yī)院神經(jīng)外科資料齊全的119例神經(jīng)膠質(zhì)瘤患者臨床資料，搜集患者病例資料。其中包括：性別，男性66例，女性53例；年齡大于50歲70例，小于50歲49例；術(shù)前KPS評(píng)分大于等于70分63例，小于70分56例；術(shù)前存在癲癇患者14例，無(wú)癲癇患者104例；術(shù)前腫瘤直徑大于等于5cm的患者有89例，小于5cm的有30例；手術(shù)全切者90例，次全切除29例；將術(shù)后病理級(jí)別根據(jù)WHO分級(jí)劃分為高級(jí)別組（WHO III~IV級(jí)，High GradeGlioma）和低級(jí)別組（WHO I~II級(jí)，Low Grade Glioma, LGG）,HGG83例，LGG36例；腫瘤細(xì)胞Ki-67指數(shù)＜10%有49例，，Ki-67≥10%有42例；術(shù)后進(jìn)行放療92例，進(jìn)行化療91例。隨訪已死亡者獲完全數(shù)據(jù)，術(shù)后死亡,術(shù)后死于非原發(fā)病者和失去隨訪者獲取截尾數(shù)據(jù)。以性別、年齡、術(shù)前KPS評(píng)分、腫瘤病理分級(jí)等10項(xiàng)因素為解釋變量，應(yīng)用COX回歸模型進(jìn)行相關(guān)因素的測(cè)定，以P0.05為統(tǒng)計(jì)學(xué)判斷標(biāo)準(zhǔn)，計(jì)算不同分組患者中位生存月，并對(duì)于各項(xiàng)參數(shù)應(yīng)用Kaplan-Meier法繪制生存曲線。結(jié)果：應(yīng)用單因素分析表明，患者發(fā)病年齡＜50歲患者（n=70）中位生存時(shí)間24個(gè)月，較年齡≥50歲（n=49）中位生存期10個(gè)月明顯延長(zhǎng)(P=0.004)；術(shù)前KPS評(píng)分≥70患者（n=63）中位生存月為26個(gè)月，高于術(shù)前KPS評(píng)分＜70患者（n=56，中位生存月13個(gè)月），P=0.001。HGG中位生存期（15個(gè)月）較LGG（43個(gè)月）明顯縮短P=0.001。腫瘤組織Ki-67指數(shù)＜10%中位生存期35個(gè)月，Ki-67指數(shù)≥10%為13個(gè)月，P=0.001。術(shù)后進(jìn)行放療患者較不進(jìn)行放療患者中位生存期延長(zhǎng)9個(gè)月（分別為21個(gè)月和12個(gè)月,P=0.009）；而COX多因素分析表明，術(shù)前KPS評(píng)分(P0.01)、腫瘤病理分級(jí)(P0.01)、腫瘤組織Ki-67指數(shù)(P0.01)及術(shù)后是否放療P0.01)4個(gè)因素對(duì)于膠質(zhì)瘤患者預(yù)后生存有相關(guān)性影響。 結(jié)論：年齡≥50歲，高級(jí)別膠質(zhì)瘤、KPS評(píng)分70及Ki-67高表達(dá)的患者預(yù)后較差，術(shù)后有效的放化療顯著改善生存期；患者的性別、腫瘤直徑大小、手術(shù)切除程度、術(shù)前有無(wú)癲癇對(duì)于膠質(zhì)瘤患者的預(yù)后影響不明顯。臨床治療中觀察以上指標(biāo)對(duì)于膠質(zhì)瘤的治療預(yù)后的判斷具有更強(qiáng)的指導(dǎo)意義
[Abstract]:Background & objective: gliomas originate from neuroectodermal tumors and are common intracranial malignant tumors. Because the recurrence rate is high, the tumor cell resistance is strong, and the symptoms may be aggravated after radiotherapy, the survival time and quality of the patients are seriously affected, resulting in serious disability and even death of the patients. This study was also to explore the relevant factors affecting the survival rule and time of glioma patients, and to find out whether there was a corresponding relationship between these factors, and to provide a reference for clinical treatment of gliomas and prognosis of glioma patients. Methods: 119 patients with glioma were collected from the first affiliated Hospital of Anhui Medical University from January to December, 2008. Including: sex, 66 males, 53 females, 70 cases aged over 50 years, 49 cases younger than 50 years, 63 cases with preoperative KPS score greater than 70 points, 56 cases with less than 70 points, 14 cases with epilepsy before operation, 104 cases without epilepsy. There were 89 cases with tumor diameter greater than or equal to 5cm before operation, 30 cases with less than 5cm, 90 cases with total resection and 29 cases with subtotal resection. According to the WHO grade, the postoperative pathological grades were divided into WHO III~IV high GradeGlioma group and WHO I~II low Grade Glioma, LGG) HGG83 cases, tumor cell Ki-67 index < 10% in 49 cases and Ki-67 鈮

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