脑恶性胶质瘤术后放化疗肿瘤复发再手术治疗的临床研究

目的 探讨脑恶性胶质瘤术后放化疗复发肿瘤再手术治疗的临床意义.方法 选取有完整 临床资料的原发恶性胶质瘤术后及其复发再手术治疗患者48 例,术后同步放和(或)化疗.采用免疫荧光双 染色法检测并比较脑胶质瘤干细胞(GSCs)标记物CD133/Nestin 在原、复发胶质瘤中的表达,Kaplan-Meier 生 存分析和Cox 回归风险模型分析原发术后放化疗肿瘤复发患者再次手术术前KPS 评分、肿瘤体积、切除程 度、GSCs 数目、两次手术间隔等因素与预后的关系.结果 CD133/Nestin 在原、复发恶性胶质瘤组织中阳性 表达百分数分别为(3.06 ±0.38)%、(14.89 ±2.54)%,差异有统计学意义(P <0.001);单Kaplan-Meier 生存 分析示原发术后放和(或)疗肿瘤复发再手术术前KPS 评分≥70 分、肿瘤全切、肿瘤体积<50 cm3 等因素显 著延长患者二次术后生存时间(P <0.05);Cox 回归风险模型分析表明再手术术前KPS 评分、肿瘤体积、切除 程度等因素可作为独立的预后因素(P <0.05).结论 脑恶性胶质瘤术后放和(或)化疗复发肿瘤富集胶质 瘤干细胞,复发胶质瘤再手术治疗是靶向胶质瘤干细胞治疗的重要举措,早期积极再次手术有益于延长患者 生存时间和提高生存质量.

Clinical research of reoperation in the treatment of patients with recurrent brain malignant gliomas after initial surgery and chemoradiotherapy

Objective To explore the clinical significance of repeat surgery for recurrent malignant gliomas after first surgical therapy combined with chemoradiotherapy. Methods The integrated clinical data of 48 patients who treated with surgical resection plus radiation and/or chemotherapy of malignant primary gliomas and underwent re-operation of recurrent tumors were collected. The co-expression of CD133 and Nestin, markers of glioma stem-like cells（ GSCs）, was assessed by immunofluorescence staining both in primary tumor samples and in recurrent tumor samples. Kaplan-Meier survival analysis and Cox proportional hazards regression modeling were used to estimate the prognostic value of potential prognostic factors, such as ： Karnofsky performance scale （KPS） score and tumor volume before reoperation,extent of removal, CD133/Nestin co-expression and the time interval between the first and second operations. Results The percentage of GSCs was significantly higher in tissue of recurrent gliomas obtained initial surgery plus radiation and/or chemotherapy （ 14. 89 ± 0. 54 ） % ] than in primary tumors （ 3.06 ± 0. 38 ） % ] as measured by double immunofluorescence staining for CD133 and Nestin（P 〈 0. 001 ）. Kaplan-Meier survival analysis demonstrated that Karnofsky performance status （KPS） ≥ 70 and tumor volume ≤ 50 cm^3 pre-repeat surgery, gross total resection significantly prolonged postoperative survival （ P 〈 0. 05 ）. Cox proportional hazards regression modeling revealed that KPS, tumor volume and the extent of removal were independent prognostic factors （ P 〈 0. 05 ）. Conclusions There is marked enrichment of GSCs in recurrent malignant gliomas after initial surgery followed by radiation and/or chemotherapy. This can provide evidence that reoperation in these patients may be of importantapplication in GSCs targeting therapy. Early, aggressive repeat surgery in these cases is recommended to be of effective in prolonging survival and extending quality and quantity of life.