本文關(guān)鍵詞： 膠質(zhì)瘤 腫瘤位置 年齡 體素分析 室管膜下區(qū) 低級別膠質(zhì)瘤 間變膠質(zhì)瘤 生存　出處：《北京協(xié)和醫(yī)學院》2016年博士論文　論文類型：學位論文

【摘要】：第一部分：膠質(zhì)瘤分布及同患者年齡關(guān)系研究[目的]描述膠質(zhì)瘤在腦內(nèi)分布情況,探究腫瘤位置同患者診斷時年齡之間的關(guān)系。[方法]我們回顧性入組了200例低級別膠質(zhì)瘤(LGG)患者和200例多形性膠質(zhì)母細胞(GBM)患者。通過人工的方法在核磁共振圖像上對腫瘤進行圖像分割并把相應(yīng)數(shù)據(jù)配準到標準腦模板中。得到高、低級別腫瘤在腦內(nèi)的分布疊加圖。然后應(yīng)用基于體素的回歸分析,尋找到同患者診斷時年齡相關(guān)的腦區(qū)。[結(jié)果]腫瘤疊加圖顯示LGG易累及左側(cè)額葉和雙側(cè)顳葉；GBM更易侵襲左側(cè)額葉/顳葉和雙側(cè)頂葉。兩組腫瘤分布均同室管膜下區(qū)(SVZ)關(guān)系緊密。腫瘤、年齡分析結(jié)果示在LGG組,同患者高齡相關(guān)的腦區(qū)主要位于右側(cè)額葉中部；而位于左側(cè)顳葉,接近SVZ的腦區(qū)同患者低齡相關(guān)。在GBM組,同患者高齡相關(guān)的腦區(qū)主要分布在顳葉,且同SVZ后部相連；位于額葉下部的腦區(qū)同患者低齡相關(guān)。兩組腫瘤中,分別位于以上區(qū)域內(nèi)的患者同腫瘤分布在其他區(qū)域的患者相比年齡具有顯著差異。[結(jié)論]本研究通過定量的方法描述了膠質(zhì)瘤的分布特點。并尋找到同患者年齡相關(guān)的腦區(qū),提示高齡、低齡患者發(fā)生腫瘤具有位置特異性。第二部分：膠質(zhì)瘤累及室管膜下區(qū)同患者預后關(guān)系研究[目的]室管膜下區(qū)(Svz)為成人神經(jīng)干細胞的主要存在區(qū)域,該區(qū)域同膠質(zhì)瘤的發(fā)生、發(fā)展和生物學行為存在緊密的聯(lián)系。腫瘤累及SVZ在多形性膠質(zhì)母細胞瘤中被認為是預后不佳的因素。本研究以較低級別膠質(zhì)瘤為研究對象,評價腫瘤累及SVZ對該部分患者預后的影響。[方法]本課題研究分別入組了143例彌漫性星形細胞瘤和160例間變膠質(zhì)瘤患者。通過核磁圖像對腫瘤和SVZ進行圖像分割,應(yīng)用定性、定量的方法對腫瘤和SVZ關(guān)系進行分析。[結(jié)果]在彌漫性星形細胞瘤組中,腫瘤累及SVZ為患者總生存期(OS)的顯著預后因素(p=0.027)。在腫瘤累及SVZ的亞組中,單因素生存分析提示腫瘤質(zhì)心距離SVZ更近時(≤30mm)患者OS更短(p=0.022)。但腫瘤累及SVZ不同亞區(qū)對患者生存無顯著影響(p=0.930)。多因素生存分析結(jié)果示在腫瘤累及SVZ的患者中,腫瘤質(zhì)心距離SVZ越近(p=0.039)患者OS越短。在間變膠質(zhì)瘤組中,單因素生存分析提示腫瘤累及SVZ同患者無進展生存期(PFS)p=0.021)和OS(p0.001)顯著相關(guān)。多因素生存分析顯示腫瘤累及SVZ為預后不佳的獨立預測因素(p=0.016,OS),而且累及SVZ枕角的患者預后更差(p0.001,PFS；p=0.016,OS).[結(jié)論]本研究提示在較低級別膠質(zhì)瘤中累及SVZ患者預后不佳,為基礎(chǔ)研究和臨床應(yīng)用提供了基礎(chǔ)。
[Abstract]:The first part: the distribution of glioma and its relationship with patient's age. [Objective] to describe the distribution of gliomas in the brain and to explore the relationship between tumor location and age at the time of diagnosis. [Methods: we retrospectively reviewed 200 patients with low grade glioma (LGG) and 200 patients with glioblastoma pleomorphic (GBM). Patient. The tumor image was segmented on MRI image by artificial method and the corresponding data was registered to the standard brain template. The distribution of low-grade tumors in the brain was superposed, and then the age related brain regions were found by using voxel based regression analysis. [Results] tumor superposition images showed that LGG easily involved the left frontal lobe and bilateral temporal lobe. GBM was more likely to invade the left frontal / temporal lobe and bilateral parietal lobe. The distribution of tumors in both groups was closely related to the subependymal area. The age analysis showed that the tumor was found in the LGG group. The brain regions associated with the patient's old age were mainly located in the middle of the right frontal lobe. In the GBM group, the brain regions related to the elderly patients were mainly located in the temporal lobe and connected with the posterior part of SVZ. The brain area located in the lower part of the frontal lobe was associated with the younger age of the patients. In the two groups of tumors, the patients located in the above regions were significantly different in age compared with those in the other regions of the tumors. [Conclusion] in this study, the distribution of gliomas was described by quantitative method, and the brain regions related to the patients' age were found. Tumorigenesis in young patients is location-specific. Part two: relationship between subependymal area involvement and prognosis of patients with gliomas. [Objective] the subependymal area (Svz) is the main region of adult neural stem cells (NSCs), which is associated with the occurrence of glioma. There is a close relationship between development and biological behavior. Tumor involvement of SVZ in glioblastoma pleomorphic is considered to be a factor of poor prognosis. To evaluate the effect of tumor involvement with SVZ on the prognosis of these patients. [Methods: in this study, 143 patients with diffuse astrocytoma and 160 patients with anaplastic glioma were studied. The images of tumor and SVZ were segmented by nuclear magnetic imaging and qualitative analysis was used. The relationship between tumor and SVZ was analyzed by quantitative method. [Results] in diffuse astrocytoma group, SVZ involvement was a significant prognostic factor for the total survival time of patients with astrocytoma. Univariate survival analysis showed that patients with tumor centroid closer to SVZ (鈮，

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