成人髓母细胞瘤患者的预后影响因素分析

目的探讨成人髓母细胞瘤(MB)患者性别、肿瘤部位、免疫组化指标、是否全切、辅助放化疗等临床、病理因素对预后的影响。方法回顾性分析25例成人髓母细胞瘤患者的临床资料,并对患者的预后进行电话随访。使用Kaplan-Meier曲线和Log-rank检验进行生存分析,寻找影响预后的因素。结果本组患者中,男性14例(56.0%),女性11例(44.0%),平均年龄为(25.1±5.9)岁。其中,12例患者(48.0%)的肿瘤位于小脑内,13例患者(52.0%)肿瘤突入四脑室;20例患者(80.0%)实现了肿瘤全切;23例患者(92.0%)术后进行了放疗;13例患者(52.0%)术后行化疗。本组患者的5年无进展生存和整体生存率分别为(65.9±10.6)%和(67.5±15.6)%。辅助放疗(P<0.001)和突触素阳性表达(P=0.017)与较好的5年无进展生存相关。在术后行辅助放疗的基础上,再行辅助化疗并无确切疗效(P=0.202)。结论成人髓母细胞瘤患者术后行辅助放疗是必需的,是否行辅助化疗尚存争议。辅助放疗和突触素阳性表达与较好的预后相关。免疫组化指标对评估成人髓母细胞瘤患者的预后有价值。

Prognostic factors of medulloblastoma in adults

Objective To explore the influence of gender,tumor location,immunohistochemical markers,extent of resection,adjuvant radiotherapy and chemotherapy and other clinicopathological factors on the prognosis of adult medulloblastoma(MB).Methods The clinical data of 25 adult MB patients were analyzed retrospectively,and the patients were followed up by telephone.Kaplan Meier curves and log rank tests were used for survival analysis to screen factors affecting the prognosis of adult MB patients.Results Of 25 patients,there were 14 males(56.0%)and 11 females(44.0%)with an average age of(25.1±5.9)years.Among them,12 patients(48.0%)had tumors in cerebellum,13(52.0%)had tumors protruding into the fourth ventricle.20 patients(80.0%)had total tumor resection;23 patients(92.0%)underwent postoperative radiotherapy;13 patients(52.0%)underwent postoperative chemotherapy.The 5-year progression free survival rate and overall survival rate were(65.9±10.6)%and(67.5±15.6)%respectively.Adjuvant radiotherapy(P<0.001)and synaptophysin positive expression(P=0.017)were associated with better 5-year progression free survival.On the basis of postoperative adjuvant radiotherapy,adjuvant chemotherapy provided no further benefit(P=0.202).Conclusions Adjuvant radiotherapy is necessary for adult MB patients after operation.Whether adjuvant chemotherapy is necessary or not remains controversial.Adjuvant radiotherapy and positive expression of synaptophysin are associated with better prognosis.The value of immunohistochemistry in evaluating the prognosis of MB patients is established in this research.