脑胶质瘤术后间质化疗联合间质放疗及其预后影响因素分析

目的探讨脑胶质瘤术后应用间质化疗联合间质放疗（ICIR）治疗的可行性和有效性，并进一步分析预后影响因素。方法回顾性分析196例脑胶质瘤患者的临床资料。其中68例，术后应用盐酸尼莫司汀（ACNU）行间质化疗，联合^125I行ICIR。另128术后行系统化疗＋颅外放疗（SCR）。统计分析病人的生存曲线和生存率，单因素和多因素分析采用Cox比例风险模型和逐步回归分析。结果ICIR病例与SCR病例的1、2、5年生存率分别为95．6％、79．4％、27．9％和82.3％、68．7％、20．3％；ICIR和SCR病例中位生存期分别为89．6周和56．6周；ICIR和SCR病例KPS预后计分分别为（85．3±5．7）分和（63．6±4．2）分。两者疗效比较有显著差异性（P〈0．05）。患者的年龄、KPS评分、肿瘤病理分级、肿瘤明显强化与否以及ICIR治疗是影响预后的独立因素。结论ICIR治疗脑胶质瘤具有明显的疗效。年龄〈40岁、KPS评分≥70、Kernohan分级I-Ⅱ级和无明显强化以及ICIR治疗是影响脑胶质瘤良好预后的因素。

Interstitial Chemotherapy Combined With Interstitial Radiotherapy for Postoperative Gliomas and Analysis of Factors Related to Their Prognosis

Objectives To explore curative effects of interstitial chemotherapy combined with interstitial radiotherapy （ICIR） on the postoperative gliomas, and the factors related to the prognosis in the patients with gliomas undergoing microsurgery. Methods The clinical data of 196 patients with gliomas undergoing total or subtotal resection of the gliomas under an operation microscope, of whom, 68 received interstitial chemotherapy by Nimustine （ACNU） and interstitial radiotherapy by ^125I and 128 received systematical chemotherapy and routine radiotherapy （SCR）, were analyzed retrospectively. Survival curve and survival rate were analyzed by Kaplan- Meier method and Log-rank test. Cox proportional hazards model and recursive partitioning analysis were used for univariate and multivariate analysis of the factors related to the prognosis. Results The survival rates of 1, 2 and 5 years were 95.6% ,79.4% and 27.9% respectively in ICIR group, and 82.3%, 68.7% and 20.3% respectively in SCR group. The median survival time （89.6 weeks） in ICIR group was significantly longer than that （56.6 weeks） in SCR group （P〈0.05）. The patientsj age, preoperative KPS, pathological grade, tumor size and ICIR or not were the independent factors related to the prognosis in the patients with gliomas undergoing microsurgery. Conclusions The curative effect of ICIR on the postoperative residual gliomas is good. Patient＇s age〈40 years, KPS ≥70, Kernohan I - II grade, non-enhancement tumor, ICIR were regarded as good prognostic factors in the patients with postoperative residual gliomas.