荧光素钠术中荧光辅助显微手术切除脑胶质瘤的研究进展

胶质瘤是颅内最常见的原发性恶性肿瘤[1],以手术治疗为主,但预后较差,高级别胶质瘤(high-grade glioma,HGG)即使采用手术联合术后放化疗及免疫分子靶向治疗等综合治疗,5年生存率仍低于9.8％.肿瘤切除程度为预测无进展生存期(progression-free survival,PFS)、总生存期(ove...     

老年胶质瘤临床分析

目的探讨老年胶质瘤的临床诊疗特点。方法回顾性分析24例老年(年龄≥60岁)胶质瘤的临床资料,平均年龄64.7岁,合并其他系统疾病17例,均经手术治疗。结果术后最常见并发症为神经功能障碍、颅内和肺部感染。20例病人随访2.4~38.5个月,1年生存率为54.9%,2年生存率为36.6%。术后替莫唑胺(TMZ)同步放化疗者平均生存期为(29.8±5.0)个月,术后单纯化疗者为(6.6±1.3)个月,单纯手术者为(6.2±2.4)个月。结论老年胶质瘤容易误诊,合并症多,需加强围手术期管理,最大安全范围切除肿瘤,术后进一步行TMZ同步放化疗可延长生存期。     

高级别胶质瘤的预后影响因素分析

目的探讨影响高级别胶质瘤预后的相关因素。方法对新疆医科大学第一附属医院神经外科中心2013年1月—2015年12月,行手术切除的384例高级别胶质瘤患者的临床资料进行回顾性分析。排除非手术因素死亡,采用Kaplan-Meier法进行生存率分析,以及Cox比例风险回归模型进行预后多因素分析。结果本组患者中,WHOⅢ级164例,WHOⅣ级220例,均接受同组医生手术。术后接受放疗、化疗者分别为212例和243例。随访1年、3年的总体生存率分别为73. 7%、17. 1%; WHOⅢ级患者的1年、3年生存率分别为92. 3%、29. 5%,WHOⅣ级患者的1年、3年生存率分别为60. 2%、11. 7%。多因素分析显示术后辅助放疗、化疗显著提高高级别胶质瘤患者的生存率(P 0. 05)。Cox比例风险回归模型分析显示,年龄 60岁(RR=1. 701; P=0. 016)、术前KPS评分70分(RR=2. 231; P 0. 001)、WHOⅣ级(RR=2. 181;P 0. 001)、肿瘤未全切(RR=2. 101; P 0. 001)、术后未联合放化疗(RR=1. 562; P=0. 007),是影响高级别胶质瘤总体生存率的独立危险因素。而性别、肿瘤大小、有无坏死/囊变,总生存期差异均无统计学意义(均P 0. 05)。年龄60岁、术前KPS评分≥70分、WHOⅢ级胶质瘤、肿瘤全切、术后联合放化疗患者的总生存期较长。结论发病年龄60岁、KPS≥70分、WHO级别低(Ⅲ级)、肿瘤全切、术后放化疗的高级别胶质瘤患者的预后较好;术后联合进行放化疗可以提高胶质瘤的疗效。     

大脑半球高级别胶质瘤患者外科治疗后无进展生存期的影响因素分析

目的分析大脑半球高级别胶质瘤患者外科治疗后无进展生存期的影响因素。方法选择2012-03—2015-03在我院进行大脑半球高级别胶质瘤外科治疗的患者100例,根据无进展生存期分为对照组和观察组,对照组无进展生存期2a,观察组无进展生存期2a,所有患者均接受同一位医师手术治疗。对比2组患者年龄、肿瘤大小、卫星灶、坏死水肿程度、术前化疗、术后放疗等情况,采用多因素分析年龄、肿瘤大小、卫星灶、术前化疗、术后放疗等因素与无进展生存期(PFS)的相关性。结果年龄≥50岁、肿瘤≥4cm、有卫星灶、术前无化疗、术后无放疗为大脑半球高级别胶质瘤患者术后无进展生存期的影响因素(P0.05)。结论肿瘤坏死程度和水肿程度与大脑半球高级别胶质瘤患者外科治疗后无进展生存期相关,仍应积极倡导术前化疗和术后放疗。     

高级别脑内神经胶质瘤术后生存期限影响因素分析

目的分析高级别脑内神经胶质瘤术后生存期限的影响因素。方法选择2008-01—2012-12手术治疗的Ⅲ、Ⅳ级脑内神经胶质细胞瘤256例,进行定期随访,统计术后24个月生存率,并分析其影响因素。结果Ⅲ、Ⅳ级脑内神经胶质细胞瘤患者术后24个月生存率为46.09%(118/256),小脑、直径5cm、Ⅳ级、KPS评分70、Ki67指数阳性、术后规范放疗脑内神经胶质瘤术后24个月生存率明显低于大脑、直径≤5cm、Ⅲ级、KPS评分70、Ki67指数阴性、术后不规范放疗者,差异有统计学意义(P0.05)。肿瘤部位、肿瘤大小、病理分级、KPS评分、Ki67指数、术后辅助放疗是脑内神经胶质瘤术后生存期限独立危险因素(OR=0.529、1.048、0.179、1.798、0.886、1.046,P0.05)。结论高级别脑内神经胶质瘤术后24个月生存率较低,发病部位、肿瘤大小、病理分级、KPS评分、Ki67指数、术后辅助放疗是其生存期限的独立危险因素。     

双额叶高级别脑胶质瘤显微手术切除25例分析

目的探讨双额叶高级别脑胶质瘤的手术方法与生存期的相关性。方法选取25例双额叶高级别脑胶质瘤并接受手术及放化疗患者的临床资料进行回顾性分析,分析手术切除程度、临床症状与生存期的相关性。结果手术治疗的25例患者中,Ⅰ型切除11例,Ⅱ型切除8例,Ⅲ型切除6例,与手术前对比,术后患者临床症状均有明显好转,卡氏功能评分系统(Karnofsky Performance Status,KPS)评分升高(P0.05);手术切除程度越不彻底,生存期越短。结论手术治疗能够改善患者的生活质量、延长生存时间。     

手术切除程度对高级别胶质瘤病人预后的影响:单中心303例病例研究

目的探讨手术切除程度对高级别胶质瘤病人预后的影响。方法回顾性分析303例高级别胶质瘤病人的临床资料,包括间变型胶质瘤(WHOⅢ级)126例,胶质母细胞瘤(WHOⅣ级)177例。均进行异柠檬酸脱氢酶(IDH)基因检测,并统计分析各项临床资料数据与总生存期(OS)的关系。结果单变量分析显示:年龄55岁,全部完成放化疗方案,IDH-1R132H基因突变型,术前KPS评分≥70分,WHOⅢ级肿瘤及手术全切除病人的中位OS更长(P0.05)。Kaplan-Meier生存曲线显示:肿瘤切除程度越高,病人预后越好(P0.05)。多变量分析显示:年龄、病理级别、手术切除程度、放化疗和IDH-1132H基因类型均是预测病人预后的独立风险指标。结论高级别胶质瘤预后差,需要手术结合术后放化疗综合治疗;肿瘤全切除对延长病人OS、提高生活质量具有重要意义。     

手术联合125I粒子植入治疗复发高级别胶质瘤的临床初步应用

目的 探讨采用手术联合¹²⁵I放射性粒子植入治疗复发高级别胶质瘤的安全性与可行性,并与手术联合常规放疗的疗效进行比较。方法 选取2014年10月—2019年1月浙江大学附属金华医院神经外科收治的复发高级别胶质瘤63例,根据治疗方式分为粒子组(n=27)和对照组(n=36)。所有患者均行开颅肿瘤切除,粒子组患者术中在黄荧光和神经导航引导下根据术前TPS方案植入¹²⁵I放射粒子,对照组术后则行常规放疗,同时比较两组患者随访情况。结果 两组术后并发症发生率、术后1个月和3个月的KPS评分无统计学差异(P>0.05),但粒子组术后6个月KPS评分(t=1.143,P=0.023)、2年生存率(X²=4.855,P=0.028)更高,中位生存时间(X²=1.570,P<0.001)更长。结论 手术联合¹²⁵I放射性粒子植入治疗复发高级别胶质瘤是一种可行且安全的治疗方式,可提高患者生存质量和总体生存率,并延长生存时间。     

肿瘤切除术联合卡莫司汀缓释植入剂治疗高级别脑胶质瘤的临床研究

目的探究肿瘤切除术联合卡莫司汀缓释植入剂治疗高级别脑胶质瘤的临床疗效。方法选取2012年1月至2014年1月本院收治的60例经MRI和冷冻病理初步诊断为高级别恶性脑胶质瘤的患者,按照2:1分配病例数及分层随机方法将患者分为试验组(40例)、对照组(20例),所有患者均给予显微手术治疗,肿瘤切除后,试验组瘤腔内置入卡莫司汀缓释植入剂,对照组瘤腔内置入安慰剂。比较两组患者的总生存期(OS)及12个月生存率,并进行生活质量评价及安全性分析。结果试验组OS生存曲线和PFS生存曲线均优于对照组,比较差异有统计学意义(P0.05);与术前相比,两组患者术后1w、术后1个月、术后3个月、术后6个月的KPS评分、QOL评分均升高,随时间进展呈先升高后降低的趋势,以术后1个月最高,手术前后不同时间点比较差异有统计学意义(P0.05);试验组术后不同时间点的KPS评分、QOL评分均高于对照组术后相应时间点(P0.05);在12个月生存率方面,试验组高于对照组,比较差异有统计学意义(χ~2=4.66,P0.05);在不良反应总发生率方面,试验组较对照组无明显增加,(χ~2=0.33,P0.05)。结论肿瘤切除术联合卡莫司汀缓释植入剂治疗高级别脑胶质瘤患者的临床效果显著,值得在临床上推广应用。     

术后长周期替莫唑胺治疗高级别胶质瘤的研究

目的 分析术后长周期(≥9周期)替莫唑胺(TMZ)治疗高级别胶质瘤的效果、不良反应及对预后的影响.方法 收集高级别胶质瘤患者100例,根据术后使用TMZ的周期数不同,分为标准周期(6周期)与长周期(≥9周期)治疗组.分析比较两组患者的无进展生存期(PFS)和总生存期(OS),以及对预后的影响因素.结果 标准周期组患者的...     

173例胶质瘤预后的影响因素分析

目的 探讨影响胶质瘤预后的相关因素。方法 对2000年1月至2009年12月在中山大学肿瘤防治中心首次手术病理确诊为胶质瘤的临床资料进行回顾性分析,并排除因非肿瘤因素死亡患者,采用Kaplan-Meier法进行生存率估计及Cox比例风险回归模型进行预后多因素分析。结果 本组纳入胶质瘤173例,其中WHO Ⅰ级10例,Ⅱ级61例,Ⅲ级53例,Ⅳ级49例;98例术后接受放疗[高级别胶质瘤（WHOⅢ~Ⅳ级）61例,低级别胶质瘤（WHO Ⅰ~Ⅱ级）37例];60例术后接受化疗（高级别胶质瘤46例,低级别胶质瘤14例）。本组患者1、3、5年总体生存率分别为74.0%、42.2%、32.4%;WHO Ⅰ、Ⅱ、Ⅲ、Ⅳ级的 5年生存率分别为80.0%、52.5%、24.5%、6.1%。分层分析显示术后辅助放化疗显著影响高级别胶质瘤生存率（P <0.05）。Cox比例风险回归模型分析结果 显示,年龄>40岁（RR=1.603;P=0.019）、WHO Ⅲ~Ⅳ分级（RR=2.311;P <0.001）、肿瘤未全切（RR=2.108;P <0.001）、术后未放疗（RR=1.652;P=0.008）是影响胶质瘤总体生存率的独立危险因素。结论 本组病例的分析结果 提示,发病年龄≤40岁、WHO级别低、肿瘤全切的胶质瘤患者预后好;术后进行放疗可以提高胶质瘤的疗效。     

Effects of palliative treatment with temozolomide in patients with high-grade gliomas

BACKGROUND AND PURPOSE: The aim of the study was to assess the results of treatment with temozolomide in patients with high-grade gliomas who no longer benefit from surgical treatment and radiotherapy. MATERIAL AND METHODS: The retrospective analysis included 51 patients treated between 2001 and 2007 in the Centre of Oncology in Kraków. Glioblastoma multiforme was histologically diagnosed in 24 (47%) patients; anaplastic astrocytomas and other grade III gliomas (according to WHO classification) were diagnosed in 27 (53%) patients. Patients received 1-11 cycles of treatment with temozolomide - 210 cycles were given in total. Forty-five patients were eligible for efficacy assessment because 6 patients received only one chemotherapy cycle (due to rapid progression of the glioma). RESULTS: According to the radiological assessment, 6 patients (13%) had an objective response and a further 16 patients (36%) had stabilization of the glioma. Subjective improvement was noted in 26 patients (58%), and neurological improvement was observed in 14 patients (31%). The median survival in the whole group was 41 weeks (40 weeks in patients with glioblastoma multiforme and 54 weeks in patients with anaplastic gliomas). One-year overall survival in the above-mentioned groups was 40.7%, 22%, and 50%, respectively. Two-year overall survival was 16%, 8%, and 20.9%, respectively. Adverse events were observed during 73 (35%) cycles of treatment and prompted a dose reduction in 12 (24.5%) patients. The most frequent adverse events were: thrombocytopenia, leukopenia, nausea and vomiting. Adverse events did not lead to treatment withdrawal in any patient. CONCLUSIONS: Objective benefit from the temozolomide treatment (stabilization or objective remission) was observed in 49% of patients irrespective of histological diagnosis. Tolerability of treatment with temozolomide in patients with high-grade gliomas is good.     

规范治疗与脑胶质瘤患者的预后

目的探讨规范治疗对改善脑胶质瘤患者预后的重要意义。方法收集自2000年1月至2006年3月在我院治疗的有完整病案记录、随访资料和明确病理诊断的149例脑胶质瘤患者的资料。参照2005年美国National Comprehensive Cancer Network的诊疗规范，以及中山大学肿瘤防治中心脑胶质瘤单病种诊疗指引，将149例胶质瘤患者按照治疗情况分为规范治疗与不规范治疗两组，并对患者术后的生存状况及功能情况进行评估。结果低级别胶质瘤患者的中位生存时间规范治疗组为85个月和不规范治疗组为42个月，高级别胶质瘤患者规范治疗组为51个月，不规范治疗组为23个月，两组相较，均差异显著（P〈0．01）。低级别胶质瘤患者无疾病进展生存时间规范治疗组为66个月，不规范治疗组为33个月；高级别胶质瘤患者规范治疗组为32个月，不规范治疗组为13个月，两组相较，均差异显著（P〈0.01）。规范治疗组高、低级别胶质瘤患者的一年、两年及五年生存率均高于不规范治疗组（P〈0．05）。治疗后规范治疗组患者KPS功能评分显著高于不规范治疗组（P〈0．01）。结论规范治疗能明显改善脑胶质瘤患者预后，延长其生存时间，提高其生活质量，所以在神经肿瘤医生中强调对胶质瘤的规范治疗十分迫切。     

Predictive factors for overall survival in surgical cases of gliomatosis cerebri from the National Cancer Database

Gliomatosis Cerebri (GC) is a rare, aggressive, diffusely infiltrating cerebral tumor. Prognostic indicators and management strategies are currently poorly characterized. The National Cancer Database was queried for patients with histologically confirmed GC between 2004 and 2016. Demographic, tumor, and treatment characteristics were collected, including the Charlson/Deyo score, a comorbidity index adapted from the Charleston Comorbidity Index. Allowable values for the Charlson/Deyo score are 0 (no recorded comorbidities), 1, 2, and 3+ (most severe). Factors associated with overall survival were identified via bivariate log-rank tests and multivariate stepwise Cox proportional hazards models. The query returned 108 GC patients. The median age was 60.0 years, males were predominantly affected (63%), and most patients were white (86%). While 12% of cases achieved near/gross total resection and 27% of cases achieved partial resection, most surgeries were for biopsy (61%). Treatments included radiation therapy in 64% and chemotherapy in 63% of patients. The median overall survival was 15.1 (95% confidence interval [CI] = 11.1–24.8) months. On bivariate analysis, chemotherapy improved overall survival (p = 0.01) while radiation therapy (p = 0.07) and extent of resection (p = 0.48) did not. On multivariate analysis, older patients (hazard ratio [HR] = 1.07, CI = 1.03–1.11, p < 0.01) and Charlson/Deyo scores of ≥1 versus 0 (HR = 3.47, CI = 1.40–8.60, p < 0.01) had significantly increased mortality risk following surgery. In particular, the Charlson/Deyo score is a novel prognostic factor for GC that may guide clinical and surgical decision-making for this rare, rapidly fatal tumor. Further prospective studies are warranted to clarify the effects of chemotherapy versus radiation as treatment modalities for GC.     

球囊法32P内放疗同步内化疗综合治疗脑胶质瘤的临床研究

目的 比较研究单纯球囊法32P内放疗和球囊法32P内放化疗对脑胶质瘤患者的临床疗效. 方法 将山东省临沂市沂水中心医院收治的脑胶质瘤患者228例分为3组,A组64例为普通放疗组,B组93例为单纯球囊法32P内放疗组,C组71例为球囊法32P内放化疗组,比较3组患者治疗有效率,平均生存期及1、3、5年生存率,分析其疗效;比较3组患者治疗后的KPS评分,分析治疗副作用. 结果 C组患者治疗后疗效,平均生存期及1、3、5年生存率高于A组、B组,差异均有统计学意义(P<0.05);B组与A组、C组与A组治疗后KPS评分比较差异有统计学意义(P<0.05),而B组与C组差异无统计学意义(P0.05). 结论 球囊法32P内放疗治疗胶质瘤患者疗效明显优于普通放疗,球囊法32P内放化疗疗效优于单纯球囊法32P内放疗.普通放疗副作用明显大于单纯球囊法32P内放疗和球囊法32P内放化疗.而单纯球囊法32P内放疗和球囊法32P内放化疗副作用差异不大.     

High-grade glioma in children and adolescents: a single-center experience

Purpose

The aim of this study was to report the outcome in children with high-grade astrocytoma outside the brain stem and spinal cord that were treated at a single center.

Materials and methods

The study included 26 patients with anaplastic astrocytoma and 37 patients with glioblastoma; all patients were aged ≤18 years. At initial diagnosis, 18 of the patients with glioblastoma received only temozolomide (TMZ), 14 received other chemotherapies, and 5 did not receive any chemotherapy. Among the patients with anaplastic astrocytoma, 9 received TMZ, 9 received other chemotherapy regimens, and 8 patients did not receive any chemotherapy. The median radiotherapy dose in all patients was 60 Gy.

Results

Median age of the patients was 12.5 years. Median overall survival was 20 months and mean progression-free survival was 4.7–11.3 months (median: 8 months) in all patients. Patients with a Karnofsky performance score (KPS) ≥70 had median overall survival of 32 months, versus 7 months in those with a KPS < 70. Patients aged <15 years had median survival of 38 months, versus 16 months in those aged 15–18 years. Patients with anaplastic astrocytoma that received TMZ, other chemotherapy regimens, and no chemotherapy had median survival of 21 months, 132 months, and 11 months, respectively. Patients with glioblastoma that received TMZ, other chemotherapy regimens, and no chemotherapy had median survival of 32 months, 12 months, and 8 months, respectively.

Conclusion

In the present study, patients with anaplastic astrocytoma treated with chemotherapy protocols other than TMZ had the longest OS; however, in the glioblastoma group, OS was 32 months in those treated with standard TMZ and 12 months in those treated with other protocols (P = 0.493). Although TMZ is less toxic than PCV, it was not shown to be superior.

     

H3K27M突变型弥漫性中线胶质瘤的诊治分析

目的 总结H3K27M突变型弥漫性中线胶质瘤（HM-DMG）的诊治经验。方法 回顾性分析2017年9月至2020年9月手术治疗的11例HM-DMG的临床资料。术后随访至2020年9月30日。结果 11例中,肿瘤全切除1例,次全切除6例,部分切除4例。术后病理确诊为HM-DMG,WHO分级Ⅳ级10例,Ⅱ级1例。1例术后6个月复发,二次手术;4例术后行规律放、化疗,5例只化疗,1例未行放化疗。术后1个月内死亡1例,6~12个月死亡7例,12~18个月死亡1例。术后存活28 d~13个月,生存曲线分析显示,累积中位生存时间10.1个月。结论 HM-DMG属于高级别胶质瘤,确诊有赖于病理检查。即使采用手术和辅助术后放化疗等综合治疗,病人预后仍较差。     

胼胝体胶质瘤的预后影响因素(附60例分析)

目的 分析与胼胝体胶质瘤患者预后相关的临床因素.方法 回顾性分析第二军医大学长征医院神经外科自1995年1月至2007年12月收治、接受手术和行术后放、化疗的60例胼胝体胶质瘤患者的临床资料,随访其生存状况,分析性别、年龄、肿瘤部位、术前机能状况标准(KPS)评分、术前有无癫痫、肿瘤病理级别、肿瘤大小、影像学强化、手术切除程度对胼胝体胶质瘤患者生存预后的影响.结果 Kaplan-Meier法单因素分析显示年龄小、KPS评分高和胶质瘤病理级别低患者无进展生存时间(PFS)及总生存时间(OS)均较长,胶质瘤部位不同患者OS不同,相比差异均有统计学意义(P<0.05);Cox多元回归分析显示年龄、肿瘤病理级别为胼胝体胶质瘤患者PFS的影响因素,而年龄、病理级别、手术切除程度是OS的影响因素.结论 患者年龄较小、肿瘤病理级别低及切除程度高是胼胝体胶质瘤患者预后的保护因素,采取积极正确的治疗策略可使患者的预后得到改善.     

A role for preirradiation PCV chemotherapy for oligodendroglial brain tumors

Oligodendroglial tumors have been identified as a subgroup of glial neoplasms with a distinctly better response to chemotherapy and overall survival than purely astrocytic gliomas. Here we report our experience with adjuvant postirradiation and preirradiation chemotherapy using procarbazine, lomustine, and vincristine (PCV) in 27 patients with WHO grade II or III oligodendroglioma or oligoastrocytoma. The efficacy of chemotherapy was assessed according to the Macdonald response criteria (complete response, CR; partial response, PR; stable disease, SD; progressive disease, PD) and progression-free survival intervals by computed tomography or magnetic resonance imaging. First, we confirm that PCV salvage therapy for patients progressing after radiotherapy is highly effective (n = 11, 1 CR, 5 PR, 5 SD; median progression-free survival has not yet been reached, but is longer than 18 months). Second, 3 patients who received radiotherapy plus PCV as first-line therapy achieved CR and 2 achieved SD, and all 5 are progression-free with a median follow-up of 12 months. Third, given these encouraging results, 11 patients received postoperative preirradiation PCV chemotherapy and were given radiotherapy only upon progression. Preirradiation PCV chemotherapy was also effective (2 CR, 3 PR, 6 SD; median progression-free survival has not been yet reached, but is longer than 14 months). Patients with anaplastic oligoastrocytomas were as likely to respond to PCV chemotherapy, as were patients with anaplastic oligodendroglioma. Three patients who had previously responded to PCV were successfully treated with a second course of PCV upon recurrence. PCV chemotherapy was also effective in patients with leptomeningeal spread of oligodendrogliomas. A randomized prospective trial is required to compare the effectiveness and neurotoxicity of first-line PCV chemotherapy followed by radiotherapy to the traditional reverse sequence. Received: 20 September 1999/Received in revised form: /1 December 1999/Accepted: 31 December 1999