【摘要】：目的:探討影響高級別腦膠質(zhì)瘤術(shù)后復(fù)發(fā)的相關(guān)因素,為臨床對腦膠質(zhì)瘤預(yù)后的判斷提供幫助,為高級別膠質(zhì)瘤患者的術(shù)后治療提供更多的理論依據(jù)。方法:收集2013年1月至2015年8月在青島大學(xué)附屬醫(yī)院神經(jīng)外科手術(shù)治療的150例高級別腦膠質(zhì)瘤患者的臨床資料。分別了解患者的性別、年齡、術(shù)前KPS評分、術(shù)前癲癇發(fā)作情況、腫瘤切除范圍、腫瘤病理級別、術(shù)后放化療情況、腫瘤分子標(biāo)志物IDH1的突變狀態(tài)、Ki-67的表達(dá)水平。其中男性82例,女性68例;年齡≤50歲84例,50歲66例;按照WHO分級,Ⅲ級腦膠質(zhì)瘤84例,Ⅳ級腦膠質(zhì)瘤66例;術(shù)后行化療者38例,未化療者112例;術(shù)后行放療者44例,未放療者106例。腫瘤分子標(biāo)志物IDH1野生型86例,IDH1突變型64例。采用病歷查詢及電話隨訪等方式了解患者的術(shù)后情況,患者術(shù)后放療采用三維適形放療(3D-CRT)或調(diào)強(qiáng)放療(IMRT)技術(shù),術(shù)后化療藥物應(yīng)用替莫唑胺膠囊(TMZ)。隨訪至患者的疾病復(fù)發(fā)。術(shù)后復(fù)發(fā)時間定義為首次行膠質(zhì)瘤切除術(shù)至定期影像學(xué)復(fù)查發(fā)現(xiàn)復(fù)發(fā)病灶的間隔時間。應(yīng)用SPSS 19.0軟件對數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析,以P0.05為統(tǒng)計學(xué)判定標(biāo)準(zhǔn)。首先應(yīng)用t檢驗了解每項指標(biāo)的平均復(fù)發(fā)時間;根據(jù)術(shù)后復(fù)發(fā)情況,再應(yīng)用?2檢驗進(jìn)行單因素分析篩選與術(shù)后復(fù)發(fā)相關(guān)的因素;最后應(yīng)用多元Logistic逐步回歸分析得出高級別腦膠質(zhì)瘤患者術(shù)后復(fù)發(fā)的獨立影響因素。對患者的年齡、腫瘤病理級別、IDH1突變狀態(tài)及Ki-67表達(dá)水平之間的相關(guān)性檢驗應(yīng)用Spearman相關(guān)性分析。結(jié)果:術(shù)后復(fù)發(fā)情況:年齡≤50歲組患者平均復(fù)發(fā)時間為11.97個月,年齡50歲組患者平均復(fù)發(fā)時間為7.46個月(P0.05);術(shù)前有癲癇發(fā)作患者平均復(fù)發(fā)時間為12.07個月,無癲癇發(fā)作患者平均復(fù)發(fā)時間為9.12個月(P0.05);術(shù)后接受放療患者平均復(fù)發(fā)時間為13.20個月,未接受放療患者平均復(fù)發(fā)時間為8.65個月(P0.05);術(shù)后接受化療患者平均復(fù)發(fā)時間為14.62個月,未接受化療患者平均復(fù)發(fā)時間為8.41個月(P0.05);IDH1突變型患者平均復(fù)發(fā)時間為13.42個月,IDH1野生型患者平均復(fù)發(fā)時間為7.42個月(P0.05);Ki-67陽性率≤25%患者平均復(fù)發(fā)時間為12.13個月,Ki-67陽性率25%患者平均復(fù)發(fā)時間為8.38個月(P0.05)。單因素分析結(jié)果:單因素分析結(jié)果顯示年齡(P0.05)、術(shù)前癲癇發(fā)作情況(P0.05)、腫瘤病理級別(P0.05)、術(shù)后放療(P0.05)、術(shù)后化療(P0.05)、腫瘤分子標(biāo)志物IDH1的突變狀態(tài)(P0.05)具有統(tǒng)計學(xué)意義。多因素分析結(jié)果:多元Logistic逐步回歸分析結(jié)果提示年齡(P0.05)、術(shù)后放療(P0.05)、術(shù)后化療(P0.05)、IDH1突變狀態(tài)(P0.05)是高級別腦膠質(zhì)瘤患者術(shù)后復(fù)發(fā)的獨立影響因素。相關(guān)性分析結(jié)果顯示:患者的年齡與腫瘤病理級別呈正相關(guān)(r=0.2965,P0.05);腫瘤病理級別與Ki-67表達(dá)水平呈正相關(guān)(r=0.5599,P0.05);IDH1突變狀態(tài)與Ki-67表達(dá)水平呈負(fù)相關(guān)(r=-0.3932,P0.05)。結(jié)論:高級別腦膠質(zhì)瘤患者年齡50歲、術(shù)后未行放化療、腫瘤分子標(biāo)志物IDH1野生型是術(shù)后復(fù)發(fā)的獨立危險因素,而性別、術(shù)前KPS評分、術(shù)前癲癇發(fā)作情況、腫瘤切除范圍、腫瘤病理級別及Ki-67的表達(dá)水平對患者術(shù)后復(fù)發(fā)影響不明顯。術(shù)后行放療及替莫唑胺輔助化療可以延緩疾病復(fù)發(fā)。因此,在今后高級別腦膠質(zhì)瘤患者的治療及預(yù)后判斷方面,需全面了解患者的一般狀況,綜合考慮各項因素對患者的影響,重點考察患者年齡、術(shù)后放化療情況、腫瘤分子標(biāo)志物表達(dá)情況等,給予最合理最優(yōu)化的治療方法與治療建議,延緩疾病復(fù)發(fā)改善患者預(yù)后。
[Abstract]:Objective: To explore the related factors affecting the recurrence of high-grade gliomas, and to provide more theoretical basis for the prognosis of high-grade gliomas. Methods: 150 cases of high-grade gliomas treated by neurosurgery in the Affiliated Hospital of Qingdao University from January 2013 to August 2015 were collected. The clinical data of patients with glioma were analyzed, including sex, age, preoperative KPS score, preoperative seizures, tumor resection range, tumor pathological grade, postoperative radiotherapy and chemotherapy, mutation of tumor molecular marker IDH1 and expression of Ki-67. WHO grading, grade III glioma 84 cases, grade IV glioma 66 cases; postoperative chemotherapy 38 cases, 112 cases without chemotherapy; postoperative radiotherapy 44 cases, 106 cases without radiotherapy. Tumor molecular marker IDH1 wild type 86 cases, IDH1 mutation 64 cases. Three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT) were performed with temozolomide capsule (TMZ) as the postoperative chemotherapy drug. The patients were followed up until the recurrence of the disease. P 0.05 was used as the statistical criterion. First, t test was used to find out the average recurrence time of each index, then? 2 test was used to screen the factors related to the recurrence after surgery. Finally, multiple logistic stepwise regression analysis was used to determine the independent influencing factors of the recurrence of high-grade glioma patients. Results: The average recurrence time was 11.97 months in patients younger than 50 years old, and 7.46 months in patients aged 50 years old (P 0.05). The average recurrence time was 12.07 months, the average recurrence time was 9.12 months (P 0.05) for patients without epilepsy, 13.20 months for patients receiving radiotherapy after surgery, 8.65 months for patients not receiving radiotherapy (P 0.05), 14.62 months for patients receiving chemotherapy after surgery and 14.62 months for patients not receiving chemotherapy. The average recurrence time was 8.41 months (P 0.05), 13.42 months for IDH1 mutation patients, 7.42 months for IDH1 wild type patients (P 0.05), 12.13 months for Ki-67 positive patients (< 25%) and 8.38 months for Ki-67 positive patients (< 25%). The results showed that age (P 0.05), preoperative seizures (P 0.05), tumor pathological grade (P 0.05), postoperative radiotherapy (P 0.05), postoperative chemotherapy (P 0.05), and mutation status of tumor molecular marker IDH1 (P 0.05) were statistically significant. Postoperative chemotherapy (P 0.05) and IDH1 mutation (P 0.05) were independent risk factors for postoperative recurrence in patients with high-grade gliomas. Conclusion: The age of high-grade glioma patients was 50 years old, and no radiotherapy and chemotherapy were performed. Wild type of tumor marker IDH1 was an independent risk factor for postoperative recurrence. Gender, preoperative KPS score, preoperative seizures, tumor resection range, tumor pathological grade and Ki-67 expression were the independent risk factors for postoperative recurrence. Postoperative radiotherapy and temozolomide adjuvant chemotherapy can delay the recurrence of the disease. Therefore, in the future treatment and prognosis of high-grade glioma patients, it is necessary to fully understand the general situation of patients, comprehensive consideration of the impact of various factors on patients, focusing on the age of patients, postoperative radiotherapy and chemotherapy, tumor score. The expression of sub-markers and so on should be given the most reasonable and optimal treatment methods and treatment recommendations to delay the recurrence of the disease and improve the prognosis of patients.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.41

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