室管膜下区放疗对胶质母细胞瘤患者预后作用分析

目的探讨室管膜下区（SVZ）放疗对胶质母细胞瘤（GBM）患者预后作用,并分析影响GBM患者的预后因素。方法 回顾性分析2017—2020年南京医科大学附属肿瘤医院收治的52例GBM患者,根据同侧或对侧SVZ剂量中位值将患者分为高剂量组和低剂量组,比较两组患者生存差异并分析预后影响因素。结果 全组患者中位无进展生存（PFS）期17.1个月（95%CI为12.4~30.7）,中位总生存（OS）期38.3个月（95%CI为20.4~44.5）。单因素分析显示肿瘤是否累及SVZ、切除程度、MGMT基因甲基化状态是PFS的影响因素（P=0.039、0.009、0.039）。年龄、卡诺夫斯凯计分（KPS）、肿瘤是否累及SVZ、切除程度以及MGMT基因甲基化状态是OS的影响因素（P=0.018、0.043、0.038、0.020、0.019）。将SVZ剂量作为连续变量分析显示,SVZ剂量是PFS的影响因素（P<0.05）,而不是OS的影响因素（P≥0.05）。无论肿瘤是否累及SVZ,高剂量组和低剂量组生存均无显著差异。多因素分析显示肿瘤是否累及SVZ、MGMT基因甲基化状态是PFS的独立影响因素,同样也是OS的独立影响因素（均为P<0.05）。而SVZ剂量相关变量在多因素分析中均无统计学意义。结论 肿瘤累及SVZ的患者预后更差。增加同侧或对侧SVZ剂量并不能改善患者生存。SVZ放疗是否影响患者生存仍需前瞻性随机临床研究进一步证实。

Effect of subventricular zone irradiation on prognosis of patients with glioblastoma

Objective To investigate the role of subventricular zone (SVZ) irradiation in the prognosis of patients with glioblastoma (GBM), and to analyze the factors affecting the prognosis of patients with GBM. Methods Clinical data of 52 patients with GBM treated in the Affiliated Cancer Hospital of Nanjing Medical University from 2017 to 2020 were analyzed retrospectively. According to the median dose of ipsilateral or contralateral SVZ, the patients were divided into the high-dose group and low-dose group. The prognostic differences between two groups were compared and the prognostic factors were analyzed. Results The median progression-free survival (PFS) was 17.1 months (95%CI:12.4-30.7)and the median overall survival (OS) was 38.3 months (95%CI:20.4-44.5). Univariate analysis showed that whether the tumor invading SVZ (P = 0.039), the degree of resection (P = 0.009) and MGMT promoter methylation status (P = 0.039) were the influencing factors of PFS. Age (P = 0.018), Kanofsky performance score (P = 0.043), whether the tumor invading SVZ (P = 0.038), degree of resection (P = 0.020) and MGMT promoter methylation status (P = 0.019) were the influencing factors of OS. The analysis of SVZ dose as a continuous variable showed that SVZ dose was the influencing factor of PFS (P < 0.05) rather than OS (P ≥ 0.05). Whether the tumor invading SVZ or not, there was no significant difference in survival between the high-dose and low-dose groups. Multivariate analysis showed that whether the tumor invading SVZ and MGMT promoter methylation were the independent prognostic factor for PFS (both P < 0.05), and OS (both P < 0.05). The SVZ dose related variables were not statistically significant in multivariate analysis. Conclusions Patients with tumors directly invading SVZ achieve worse survival. Increasing the ipsilateral or contralateral SVZ dose does not improve patient survival. Whether SVZ irradiation affects the survival of patients still needs to be further confirmed by prospective randomized clinical studies.