低级脑星形细胞瘤的治疗和预后因素

目的 探讨低级脑星形细胞瘤的预后因素。方法 回顾1986～1993年经手术病理证实为Ⅰ级星形细胞瘤的69个病例,采用COX模型分析有关预后因素与生存期之间的关系。结果 表明年龄、手术前后神经机能状态、手术切除肿瘤的程度、手术后放射治疗等因素与病人的生存密切相关。结论 对低级脑星形细胞瘤的患者(尤其是青壮年者),应在尽量保存神经功能的前提下,最大限度的切除肿瘤,争取做到肿瘤的全切除、次全切除,手术后辅以放射疗法等。以提高病人的长期生存率。     

低级别星形细胞胶质瘤临床相关因素与生存分析

背景与目的：影响手术后低级别星形细胞胶质瘤预后的因素很多，对其治疗方式的选择仍有较多争议，判断预后的因素也不尽一致。本研究探讨低级别星形细胞瘤的临床相关因素与预后的关系，为脑胶质瘤的治疗选择提供理论依据。方法：应用Cox风险比例模型，行逐步回归分析研究2001年至2006年间确诊的123例低级别星形细胞瘤患者的性别、年龄、术前症状、KPS评分、发病至就诊时间、肿瘤部位、肿瘤大小、手术切除程度及术后放疗对生存时间的影响。结果：多因素分析示，术前有癫痫症状者生存时间较长（P〈0．05），术前有缺失症状（P=0.002）及发病至就诊时间短的患者（P=0．012）生存时间显著缩短。手术切除程度对生存时间无显著影响，对于术后放疗，共有51例患者（41．5％）行术后放疗，剂量在40～60Gy，无论单因素或多因素分析，其对生存时间均无显著影响（P=0．14）。结论：对于低级别星形细胞瘤，术前癫痫症状预示相对预后较好，手术切除程度及术后放疗对生存时间无明显影响。     

脑胶质瘤的显微手术治疗附47例临床总结

背景与目的:脑胶质瘤的治疗原则为以手术治疗为主的综合治疗,但手术切除的彻底与否与预后直接相关,本文探讨显微手术完全切除脑胶质瘤的疗效。方法:回顾性分析自1993年3月至2005年6月共47例脑胶质瘤患者接受显微切除手术的疗效及生存情况。结果:32例非功能区肿瘤达到全切,15例功能区肿瘤肉眼全切除,术后随访12～162个月,平均44.6个月,低级别(Ⅰ、Ⅱ级)星形细胞瘤5年生存率为(72%)13/18,最长14年,高级别(Ⅲ、Ⅳ级)星形细胞瘤5年生存率为(33.3%)4/12。结论:在保护神经功能的前提下,应运显微技术完全切除肿瘤,可提高患者生存时间。     

脊髓髓内星形细胞瘤的临床特点及治疗策略分析

背景与目的：脊髓髓内星形细胞瘤一直是临床治疗的难点，本文旨在分析脊髓髓内星形细胞瘤的临床特点及治疗策略。方法：回顾性分析北京天坛医院2011年5月至2013年5月收治的31例手术治疗的脊髓髓内星形细胞瘤患者的临床资料，包括影像表现、病理类型、手术技巧、术后疗效等，采用McCormick分级和MRI影像学评估手术疗效。结果：肿瘤全切除3例，近全切除15例，部分切除11例，活检2例；术后近期临床神经功能改善1例，无变化23例，加重7例。术后随访3．24个月。20例I～Ⅱ级星形细胞瘤患者中，改善5例，无变化12例，恶化3例；11例高级别星形细胞瘤患者中，好转1例，加重4例，无变化者3例．死亡3例。结论：有明确边界的低级别星形细胞瘤首选显微手术治疗，尽可能全切除肿瘤：对边界不清的高度恶性胶质瘤可在激光刀等辅助技术下充分减压后行放化疗等相关治疗．但预后不良。分子靶向治疗可能是今后解决此问题的关键。     

脑胶质瘤的显微手术治疗--附183例报告

背景与目的：脑胶质瘤预后差,手术为其主要治疗措施、切除程度也顾后相关。本研究探讨显微外科手术对脑胶质瘤的切除程度、术后患者的生存质量及生存时间的作用。方法：回顾性分析采用显微手术治疗的183例脑胶质瘤患者临床资料,对显微手术方法进行总结并分析肿瘤切除程度,术后患者身体机能状况评分（Karnofsky performance scale,KPS)及生存情况。针对脑胶质瘤生长部位采用不同的显微手术方法。非功能区肿瘤沿周边水肿带分离,整块切除,用大功率双极电凝,功能区肿瘤沿皮层脑沟分离,先切除瘤中心部分,再切除周围部分,用小功率电凝,重要血管区肿瘤沿血管生长方向吸除肿瘤,昼避免电凝。结果：资料完整者共183例,其中非功能区肿瘤85例,功能区肿瘤47例,重要血管区肿瘤51例,本组显微手术全切及次全切除者89.1%(16.3/183);术后KPS评分平均74分,其中23例较术前平均下降10.2分,44例较术前平均提高8.6分,余116例同术前,随访时间12-216个月,平均47.8个月,随访率100%.生存期:以末次随访日期为终点,共有113例星形细胞瘤患者得到长期随访(≥5年),其中低分级星形细胞瘤5年生存率为75.4%(52/69),高分级星形细胞瘤5年生存率为18.2%(8/14).结论:根据脑胶质瘤生长部位不同,灵活运用不同的显微手术方法,可达到在保护神经功能的前提下,最大限度地切除肿瘤的目的。     

联合应用IL-2和LAK细胞治疗脑星形细胞瘤预后分析

探讨联合应用ＩＬ┐２和ＬＡＫ细胞对脑星形细胞瘤预后的影响。方法５３例经病理证实的星形细胞瘤患者，术后行全脑放射治疗，其中１３例联合应用ＩＬ┐２和ＬＡＫ细胞治疗。结果应用Ｌｏｇｒａｎｋ检验进行单因素分析显示：肿瘤部位、病理分级、手术方式和联合应用ＩＬ┐２／ＬＡＫ细胞对生存期的影响具有统计学意义；多因素Ｃｏｘ模型分析结果显示：病理分级、手术方式、Ｋａｒｎｏｆｓｋｙ评分和联合应用ＩＬ┐２／ＬＡＫ细胞与生存期关系密切。结论全切肿瘤后联合应用ＩＬ┐２／ＬＡＫ细胞有助于延长颅内星形细胞瘤患者的生存期     

脑星形细胞瘤患者血清sIL-2R监测及意义探讨

目的：探讨可溶性白细胞像素2受体（sIL-2R)在脑星形细胞瘤发生，发展中的作用。方法：采用双抗夹心ELISA法在围手术期监测40例星形细胞瘤患者血清sIL-2R水平，同时测定40例正常健康后作对照组，结果：星形细胞瘤患者血清sIL-2R显著高于对照组，且与肿瘤病理分级与预后密切相关，术后患者sIL-2R水平明显下降。结论：血清sIL-2R与脑星形细胞瘤生物学行为有关；监测其水平有助于临床评价患者的手术疗效及预后。     

岛叶胶质瘤的手术治疗

目的：提高岛叶胶质瘤的诊断治疗效果,分析影响预后的因素,提高治疗质量。方法：结合颞叶内侧面的显微解剖特点,回顾性总结近年来我科经外侧裂显微外科治疗的7例岛叶胶质瘤的临床表现、诊断和手术方式的选择与预后及治疗结果。结果：肿瘤全切除4例,次全切除2例,大部分切除1例,术后病理按WHO分级分类,提示星形细胞瘤4例,间变型星形细胞瘤2例,少突胶质细胞瘤1例,术后症状较术前明显改善的有5例,不变1例,加重1例,无手术死亡。结论：利用脑组织的自然解剖间隙,采用显微外科技术切除肿瘤是影响肿瘤切除及其预后的重要因素。     

毛细胞型星形细胞瘤的临床特点和外科治疗

背景和目的：毛细胞型星形细胞瘤是一特殊病理类型的星形细胞瘤，本文结合我们的临床病例，探讨毛细胞型星形细胞瘤的临床特点、病理学和影像学特点以及治疗方法。方法：回顾性分析我院近7年来18例经手术病理证实的毛细胞型星形细胞瘤临床资料。结果：18例患者平均发病年龄20岁，大多位于小脑，临床表现主要为颅内压增高症和共济失调，CT和MRI可分为囊性伴囊壁结节、假囊性伴囊壁结节、实质性3种影像学表现。病理以镜下见到大量Rosenthal氏纤维为特征性改变。预后与手术切除程度有关，全切组(11例)无肿瘤复发；部分残留组(6例)肿瘤易复发(2例)和恶性变(1例)，未放疗组1例肿瘤复发，为次全切除组。结论：毛细胞型星形细胞瘤好发于年轻人和小脑，有较典型的影像学和病理学特点，应争取外科全切除。对未全切病例术后应行放疗，化疗可作为预防肿瘤复发的一种辅助治疗方法。     

外侧裂区低级别星形细胞瘤个体化治疗探讨

背景与目的：脑功能区胶质瘤的治疗是神经外科的难题之一。本研究探讨外侧裂区低级别星形细胞瘤的个体化治疗方法，以期达到满意治疗效果。方法：根据术前MRI表现，将56例外侧裂区星形细胞瘤分为4种类型。Ⅰ型：额叶为主型，16例；Ⅱ型：颞叶为主型，13例；Ⅲ型：额-颞跨侧裂型，21例；Ⅳ型：额-颞-岛叶型，6例。依肿瘤特征选择手术进路：Ⅰ型经额前外侧脑沟进路：Ⅱ型经颞前外侧脑沟进路；Ⅲ型和Ⅳ型经外侧裂池进路。在保全神经功能的前提下，显微手术尽可能全切除或多切除肿瘤。术后根据肿瘤级别和特征辅以个体化放疗和，或化疗，平均随访38个月，依据术后MRI和KPS评价治疗结果。结果：肿瘤于镜下全切除39例、次全切除8例、大部分切除6例、部分切除3例：6例遗留永久性轻度神经功能障碍：9例因肿瘤局部复发而行二次手术。术后病理学检查均为WHOⅡ级星形细胞瘤。手术前后KPS无显著性差异。结论：对外侧裂区星形细胞瘤，依据MRI表现，选择个体化的手术进路，应用显微技术，在保全神经功能的前提下，尽可能全切除或多切除肿瘤，最大限度减轻肿瘤负荷，术后辅以个体化放疗和，或化疗，可取得较好的治疗效果。     

Supratentorial astrocytomas and oligodendrogliomas treated in the MRI era.

BACKGROUND: There is at present no consensus on the policy for the treatment of patients with low-grade gliomas (LGGs). METHODS: This report is a retrospective multi-institutional study of 100 patients (ages 16-65 years) with astrocytoma (grade II), oligodendroglioma, anaplastic oligodendroglioma and anaplastic oligoastrocytoma of the supratentorial areas which were treated with surgery and postoperative radiotherapy at five university hospitals in northern Japan between 1990 and 1997 when MRI was routinely used to determine the target volume. Most patients were irradiated with 50-60 Gy. The target volume usually covered the areas with T2 prolongation of MRI with a margin of 2 cm. RESULTS: The disease-specific 5-year survival rate was 87.4% for patients with oligodendroglioma and 75.3% for patients with astrocytoma. Survival for patients with astrocytoma in the MRI era appears to be improved compared with historical controls in the literature. Patients with astrocytoma aged 40 years and under had a significantly better disease-specific survival rate than those over 40 years (P < 0.05) and patients with oligodendroglioma and oligoastrocytoma showed a similar tendency. Patients with astrocytoma who had over 50% of their tumor removed had a significantly better survival rate than those who had less than 50% removed (P < 0.05). Chemotherapy appeared to improve the disease-specific survival rate of patients with oligodendroglioma but not that of patients with astrocytoma. CONCLUSION: Oligodendroglioma has a more protracted course of disease progression than astrocytoma. This particular feature and the sensitivity of LGGs to chemotherapy as well as their relevant prognostic factors, such as age, histopathology and amount of tumor removal, should be taken into account before any decision on treatment methods for LGGs is made.     

高分级脑胶质瘤术后精确放疗患者的预后影响因素

目的:分析高分级脑胶质瘤术后精确放疗患者预后的危险因素及干预对策。方法:回顾自2009年6月至2013年6月入我院的病理诊断为高分级脑胶质瘤术后精确放疗的患者资料。对患者的一般情况如性别、年龄、手术切除程度、病理分级、化疗、放疗量、KPS评分、术前癫痫发作、总生存期（随访2年）等数据进行分析,评价高分级脑胶质瘤术后精确放疗患者预后的危险因素。结果:在123例患者中,年龄16~86岁,平均发病年龄46.9岁,男性平均发病年龄42.0岁,女性平均发病年龄49.5岁。小于40岁患者68例,大于等于40岁患者55例。从发病到明确诊断平均时间9.8月,中位生存时间19个月,1年生存率69%,2年生存率37.4%。单因素分析显示,年龄、手术切除程度、病理分级、化疗与高分级脑胶质瘤术后精确放疗患者预后显著相关（P＜0.05）,性别、放疗、术前癫痫发作、KPS评分与高分级脑胶质瘤术后精确放疗患者预后无明显相关（P>0.05）。多因素COX回归分析显示,年龄<40岁（RR=1.844,95%CI:1.047~3.249）、肿瘤全切（RR=2.348,95%CI:1.389~3.968）、病理分级3级（RR=2.632,95%CI:1.479~4.684）、同步替莫唑胺化疗（RR=0.557,95%CI:0.329~0.944）能够显著延长患者的总生存时间。结论:年龄、手术切除程度、病理分级、化疗等是高分级脑胶质瘤术后精确放疗患者生存预后的危险因素。年龄<40岁、肿瘤全切、病理分级低、同步化疗患者生存预后较好。     

89例术后高度恶性脑胶质瘤预后影响因素分析

  目的  探讨高度恶性脑胶质瘤的预后以及预后影响因素。   方法  回顾分析江西省肿瘤医院2005年4月至2011年2月收治的89例高度恶性脑胶质瘤的临床资料, 其中手术全切43例, 部分切除46例; WHO3级45例, 4级44例。   结果  全组中位生存期13个月, 2年总生存率(OS)及无进展生存率(PFS)分别为43.2%和36.9%;单因素分析显示切除程度、病理分级、年龄是OS的影响因素(P < 0.05), 切除程度、脑室系统受侵、术后放疗是PFS的影响因素(P < 0.05), 多因素分析结果显示切除程度、年龄是OS的独立影响因素(P < 0.05);切除程度、术后放疗是PFS的独立影响因素(P < 0.05);全组共41例复发, 其中原位复发65.9%, 远隔部位复发34.1%;46例脑室系统受侵者, 11例出现远隔部位复发; 其余43例, 仅3例出现远隔部位复发。   结论  手术切除程度、年龄是影响OS的独立预后因素, 术后放疗能改善PFS; 原位复发是主要复发模式, 脑室受侵增加了远处播散概率。      

Prognostic factors for survival in adult patients with cerebral low-grade glioma.

PURPOSE: To identify prognostic factors for survival in adult patients with cerebral low-grade glioma (LGG), to derive a prognostic scoring system, and to validate results using an independent data set. PATIENTS AND METHODS: European Organization for Research and Treatment of Cancer (EORTC) trial 22844 and EORTC trial 22845 are the largest phase III trials ever carried out in adult patients with LGG. The trials were designed to investigate the dosage and timing of postoperative radiotherapy in LGG. Cox analysis was performed on 322 patients from EORTC trial 22844 (construction set), and the results were validated on 288 patients from trial 22845 (validation set). Patients with pilocytic astrocytomas were excluded from this prognostic factor analysis. RESULTS: Multivariate analysis on the construction set showed that age > or = 40 years, astrocytoma histology subtype, largest diameter of the tumor > or = 6 cm, tumor crossing the midline, and presence of neurologic deficit before surgery were unfavorable prognostic factors for survival. The total number of unfavorable factors present can be used to determine the prognostic score. Presence of up to two of these factors identifies the low-risk group, whereas a higher score identifies high-risk patients. The validity of the multivariate model and of the scoring system was confirmed in the validation set. CONCLUSION: In adult patients with LGG, older age, astrocytoma histology, presence of neurologic deficits before surgery, largest tumor diameter, and tumor crossing the midline were important prognostic factors for survival. These factors can be used to identify low-risk and high-risk patients.     

Adjuvant radiotherapy following radical hysterectomy for patients with early-stage cervical carcinoma (1984-1996).

BACKGROUND AND PURPOSE: The aim of this study was to assess the results of treatment (surgery alone or surgery and postoperative radiotherapy) for early-stage cervical carcinoma and to determine the morbidity associated with adjuvant radiotherapy. A subset of these patients (n = 10) was irradiated postoperatively for tumor related negative prognostic factors only and this retrospective analysis was also performed to determine if this decision was right and if the selection for this treatment was based on the right criteria. MATERIAL AND METHODS: From 1984 to 1996, 233 women underwent radical hysterectomy as primary treatment of stage I or IIA cervical carcinoma. One hundred and fifty-six patients were treated with surgery alone (67%) and 77 patients (33%) received adjuvant radiotherapy for a, tumor related negative prognostic factors: the combination CLS(+), tumor size > or = 40 mm and poor differentiation grade or the combination tumor size > or = 40 mm and depth of invasion > or = 15 mm (n = 10), or b, positive surgical margins (n = 17), and/or c. lymphnode metastases (n = 42) and/ or d. parametrial involvement (n = 6). RESULTS: For the entire group the most important prognostic factor for survival and disease free survival was node positivity. Additional factors were depth of invasion and positive surgical margins. Thirty-five patients recurred of which 12 after surgery alone. In all these cases the relapse was in the pelvis (100%). Of the 23 recurrences after surgery and adjuvant radiotherapy 13 were seen in the pelvis (56%) (P = 0.003). All patients with negative prognostic factors and N0, received adjuvant radiotherapy (n = 10) and none of these patients recurred. The incidence of severe gastrointestinal radiation related side effects was low (2%). The incidence of lymphedema of the leg was 11% which was similar in the surgery alone group. CONCLUSIONS: The relatively low percentage of radiation related side effects together with 0% recurrence in a subgroup of node negative patients with high risk of recurrence, and a relatively low percentage of recurrence in the surgery alone group lead us to the conclusion that postoperative radiotherapy in special subsets of node negative patients is justified.     

Limb-sparing treatment for soft tissue sarcomas: Influence of prognostic factors

At present, limb-sparing surgery is the most appropriate and acceptable treatment available for sarcomas of the extremities, although the right balance between conservative therapy and maximum efficacy has yet to be found. A better knowledge of prognostic factors may help in planning the appropriate strategy for each case. Eighty patients underwent limb-sparing surgery for limb sarcomas (17 had surgery alone; 19 had neo-adjuvant hyperthermic antiblastic perfusion combined or not with postoperative radiotherapy, and 44 had adjuvant radiotherapy). Univariate and multivariate analyses were made to detect statistically significant differences between subgroups and identify the more significant subset of prognostic factors. Only microscopically positive surgical margins were related to a greater risk of local recurrence, whereas overall survival was compromised by high grade and large tumor size. © 1996 Wiley-Liss, Inc.     

影响脑胶质瘤术后生存时间的因素分析（附56 例随访报告）*

目的:了解脑胶质瘤生长部位、手术方式、病理分级和术后治疗对患者术后生存时间的影响。方法:对第三军医大学西南医院2000年7 月～2007年5 月间经手术治疗的脑胶质细胞瘤患者中56例进行随访,分析肿瘤生长部位、手术切除程度、病理分级和术后治疗与患者术后生存时间的关系。结果:本组病例肿瘤位于大脑半球者48例,术后1 年生存率和3 年生存率分别为43.8% 和12.5% ,位于小脑半球者6 例,术后1 年生存率和3 年生存率分别为100% 和66.7% ,差异显著。肿瘤达肉眼全切的患者1 年和5 年生存率最高,分别为61.1% 和38.9% ,大部分切除者次之,分别为59.1% 和13.6% ,而部分切除或活检或活检者最短,分别为18.8% 和0。Ⅰ～Ⅱ星形胶质细胞瘤术后1 年和5 年生存率分别为68.8% 和28.1% ,而Ⅲ～Ⅳ级者分别为13.6% 和0。单纯手术、手术+ 放疗、手术+ 化疗、手术+ 放疗+ 化疗治疗的患者1 年生存率分别为16.7% 、63.6% 、71.4% 、78.6% ,5 年生存率分别为0、27.3% 、14.3% 、42.9% 。提示高级别胶质瘤患者的生存期短;小脑胶质细胞瘤患者术后生存时间明显高于大脑半球和丘脑区肿瘤;而手术切除肿瘤的彻底性仍是影响胶质瘤患者术后生存期最重要的因素,手术显微镜下肿瘤全切除和大部切除的术后生存时间明显优于部分切除或活检;术后放、化疗等综合治疗能显著延长患者的生存期。结论:手术方式、病理分级及术后治疗均能影响脑胶质细胞瘤患者术后生存时间,其中手术显微镜下全切和有效的术后治疗起决定作用。      

Selection of Eligible Patients with Supratentorial Glioblastoma Multiforme for Gross Total Resection

The purpose of this study is to clarify whether gross total tumor resection can prolong the survival in adult patients with supratentorial glioblastoma multiforme (GBM), and to clarify what subset of these patients obtains a survival advantage by gross total tumor resection without postoperative neurological deterioration.Eighty-two adult patients with supratentorial GBM were retrospectively reviewed. Overall, the median survival time was 13 months, and the 1- and 2-year survival rates were 53.7% and 14.6%, respectively. In a univariate analysis for survival rate by log-rank test, age (>40 years), Karnofsky performance scale (KPS) score (70–100%) and extent of surgery (gross total resection) were revealed to be significant good prognostic factors. A Cox proportional hazard multivariate regression analysis confirmed that the KPS and extent of surgery were independent, significant good prognostic factors. Nine patients (11%) suffered postoperative neurological deterioration.A topographical GBM staging system (Stages I, II and III) with the integration of tumor location, size and eloquence of adjacent brain based on MRI (for explanation of Stages see text) was originally proposed. In Stage I, gross total resection had a strong tendency toward a better prognostic factor in a univariate analysis and was revealed to be a significant independent good prognostic factor in a multivariate analysis. In also Stage II, the survival of patients who underwent gross total resection was better than that of patients with less than gross total resection, although not significant. In Stage III, there were no patients who underwent gross total tumor resection. Risk probabilities of postoperative neurological deterioration, overall, were 0%, 22.2%, and 20% in Stages I, II, and III, respectively, and those after gross total resection were 0% and 16.7% in Stages I and II, respectively.Although gross total tumor resection is associated with prolongation of the survival time of patients with GBM, the risk of postoperative neurological deficit increases with radical tumor resection. To select an eligible subset of patients that benefit in survival from gross total tumor resection without postoperative risk, the following surgical policy for GBM resection is suggested. GBM in Stage I should be resected as radically as possible. Regarding Stage II, risky surgical resection extending to the area adjacent to the critical zone should be avoided and more meticulous and careful surgical planning is needed than that in Stage I. In Stage III, radical gross total tumor resection is not recommended at present.     

低分割推量照射治疗43例幕上胶质母细胞瘤

目的:观察幕上胶质母细胞瘤术后常规分割照射后行低分割推量照射的疗效,分析影响生存的预后因素。方法:回顾性分析2001年12月至2005年12月行低分割推量照射治疗的43例原发性幕上胶质母细胞瘤患者的临床资料,均为单发病灶的初治患者,经手术切除或病理活检证实。采用适形照射技术,靶区包括残留灶、术后空腔及周围水肿区,根据治疗计划剂量分布特征及临近敏感器官限制剂量,设定靶区分割剂量与总照射剂量,周边水肿区常规分割剂量照射54～60Gy后,采用逐步缩野技术、个体化低分割推量照射,术后残留灶照射剂量超过70Gy。治疗结束后定期复查,观察生存得益及神经毒性反应,分析影响生存的预后因素。结果:全组中位生存时间14个月,1 年、2 年生存率分别为61% 、25% ,中位无进展生存时间为11个月,1 年、2 年无进展生存率分别为35％、11％。急性期神经毒性反应轻微,7 例发生1 级神经毒性,3 例发生后期2 级神经毒性反应,表现为中度头痛,9 例后期发生照射区域脑坏死,其中5 例经术后病理学诊断证实,4 例符合临床脑坏死诊断。多因素分析提示KPS 评分（P=0.002）、切除程度（P=0.025）及年龄（P=0.030）是影响生存的独立预后因素。结论:术后低分割推量照射是幕上胶质母细胞瘤的安全、有效的治疗手段。      

Ⅲ级和Ⅳ级脑胶质瘤术后放化疗预后分析

目的 评价Ⅲ、Ⅳ级脑胶质瘤术后放化疗的疗效及预后因素。方法 回顾分析2007-2012年间119例Ⅲ、Ⅳ级脑胶质瘤术后放疗或放化疗患者的临床资料,其中单纯放疗49例,放疗联合亚硝脲类化疗21例,放疗联合替莫唑胺化疗49例。采用Kaplan-Meier法计算总生存率和复发率,Cox模型多因素预后分析。结果 随访率为94.1%,随访时间满1、2年样本数分别为53、10例。总复发率69.7%。1、2年总生存率分别为44.5%、8.4%。多因素分析显示年龄、术前有无癫痫发作、肿瘤切除程度、放疗联合替莫唑胺化疗均是影响肿瘤复发的因素(P=0.002、0.005、0.000、0.000),上述因素加上肿瘤病理分级是影响患者生存的因素(P=0.006、0.010、0.000、0.000、0.001)。结论 Ⅲ、Ⅳ级脑胶质瘤术后患者放疗联合替莫唑胺化疗可取得较好疗效,同时年龄<;60岁、术前无癫痫发作、肿瘤全切、肿瘤病理分级Ⅲ级是影响恶性胶质瘤患者长期生存的有益因素。