低级别胶质瘤复发再次术后癫痫预后危险因素分析

目的 探讨首次术后诊断为低级别胶质瘤复发并再次手术治疗后癫痫预后的危险因素。方法 回顾性分析2012年4月至2015年4月收治的复发并再次手术治疗的81例胶质瘤的临床资料。结果 81例中，43例再次术后病理诊断仍为低级别胶质瘤（无恶性转变组），38例进展为高级别胶质瘤（恶性转变组）。再次术后12个月，无恶性转变组29例（35.8%）完全无癫痫发作（EngelⅠ级），恶性转变组为26例（32.1%）。多因素Logistic 回归分析结果表明，肿瘤全切除是恶性转变组癫痫预后的良好指标（OR=0.171，95% CI为0.031~0.941，P=0.042），肿瘤全切除（OR=0.09，95% CI为0.013~0.613；P=0.014）和Ki-67低表达（OR=0.064，95% CI为0.007~0.610；P=0.017）是无恶性转变组癫痫预后良好指标，而年龄≤38岁（OR=8.899，95% CI为1.615~60.667；P=0.013）是无恶性转变组癫痫预后不良指标。结论 肿瘤全切除、年龄>38岁以及Ki-67低表达是预测复发性低级别胶质瘤术后癫痫完全控制的良好因素，而在进展为高级别的胶质瘤中，仅有肿瘤全切除有助于癫痫完全控制。

Factors related to prognosis of seizure following reoperation for recurrent low grade gliomas

Objective To explore the factors relate to the prognosis seizure after reoperation for low grade gliomas diagnosed as at first. Methods The clinical data of 81 epileptic patients with low grade gliomas, who underwent surgery again for the recurrent gliomas from April, 2012 to April, 2015, were analyzed retrospectively. Results Of 81 patients with seizure before the second operation, 43 still had low grade gliomas and 38 progressively had high grade gliomas according to pathological diagnosis after the second operation. Of 55 patients in whom the seizures were completely controlled (Engel class Ⅰ) 12 months after the second surgery, 29 were ones with low grade gliomas and 26 were ones with high grade gliomas. The other patients still experienced seizures differently in degree (Engel classes Ⅱ~Ⅳ). The logistic regression analysis suggested that the risk factors related to seizure after the reoperation included incomplete resection of the tumors, high expression of Ki-67 and age less than 38 years (P<0.05) in="" the="" patients="" with="" low="" grade="" gliomas="" after="" reoperation,="" and="" risk="" factors="" related="" to="" seizure="" was="" incomplete="" resection="" of="" tumors="" high="" reoperation="" (P<0.05).>Conclusion The present Results suggested that gross total resection of the tumors, age over 38 years and low expression of Ki-67 were favorable factors related to predicting complete control of seizure in recurrent low grade glioma patients, but only the gross total resection of the tumors contributed to the complete control of seizure in the patients who experienced malignant transformation.