本文選題：膠質母細胞瘤 + 預后因子��； 參考：《浙江大學》2017年碩士論文

【摘要】：背景:膠質母細胞瘤是中樞神經(jīng)系統(tǒng)中惡性程度最高、預后最差的腫瘤之一,最大程度腫瘤切除及術后同步放化療為現(xiàn)階段的標準治療方案,但不同患者的預后存在較大差異,且目前為止仍未發(fā)現(xiàn)決定患者預后的核心因素。膠質母細胞瘤的異質性可能是造成預后差異的重要原因。因此,不同因素之間的交互效應可能對預后產(chǎn)生顯著的作用。目的:驗證目前已發(fā)現(xiàn)的膠質母細胞瘤預后相關因素;尋找并解讀因素間交互效應;最終為膠質母細胞瘤個體化治療方案的制定提供依據(jù)。方法:連續(xù)性地收集浙一醫(yī)院2009年4月至2015年4月間住院治療的66例膠質母細胞瘤病例。收集患者一般資料如性別、起病時年齡、基礎疾病情況、確診年份等;患者術前卡氏評分、癥狀、起病至手術時間間隔、腫瘤部位、手術治療情況、術后并發(fā)癥、放化療、復發(fā)時間、復發(fā)后治療、影像學表現(xiàn)、腫瘤分子標記物、術后生存期等。采用Cox比例風險模型進行單因素、多因素以及交互效應分析。結果:與膠質母細胞瘤總體生存期相關的獨立危險因素包括腫瘤定位于額葉[HR(95%CI):0.339(0.185-0.622),P0.001;adjusted:0.186(0.059-0.586),P=0.004]、腫瘤完全切除[HR(95%CI):0.391(0.166-0.923),P=0.032;ad justed:0.110(0.020-0.610),P=0.012]、復發(fā)后積極治療[HR(95%CI):0.321(0.118-0.871),P=0.026;adjusted:0.229(0.060-0.878),P=0.032]。與膠質母細胞瘤無進展生存期相關的獨立危險因素主要為腫瘤定位于額葉[HR(95%CI):0.412(0.227-0.748),P=0.004;adjusted:0.382(0.172-0.850),P=0.018]。除廣泛的二階交互效應網(wǎng)絡外,復發(fā)后治療、前額葉腫瘤、術前卡氏評分之間存在顯著的三階交互效應(HR:0.957,95%CI:0.920-0.996,P=0.030)。結論:因素間交互效應與膠質母細胞瘤的預后存在相關性,提示可基于交互效應進行膠質母細胞瘤預后評估、指導個體化治療方案制定。
[Abstract]:Background: glioblastoma is one of the most malignant tumors with the worst prognosis in the central nervous system. So far, no core factors have been found to determine the prognosis of patients. The heterogeneity of glioblastoma may be an important reason for the difference of prognosis. Therefore, the interaction between different factors may play a significant role in prognosis. Objective: to verify the prognostic factors of glioblastoma, to find out the interaction between the factors, and to provide the basis for the individual treatment of glioblastoma. Methods: 66 cases of glioblastoma were collected from April 2009 to April 2015 in Zhejiang first Hospital. Collect general data of patients such as gender, age at onset, condition of underlying disease, year of diagnosis, etc. The patients had preoperative Karnox score, symptoms, time interval between onset and operation, tumor location, surgical treatment, postoperative complications, radiotherapy and chemotherapy, etc. Recurrence time, post-recurrence therapy, imaging findings, tumor molecular markers, postoperative survival time, etc. Cox proportional hazard model was used to analyze single factor, multi factor and interaction effect. 緇撴灉:涓庤兌璐ㄦ瘝緇嗚優(yōu)鐦ゆ，

本文編號：2111084