合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素分析

目的探讨合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素。方法回顾性分析2015年6月至2019年1月手术治疗的80例合并癫痫的幕上低级别胶质瘤的临床资料。术后1年,采用Engel分级评估癫痫预后,Ⅰ级为预后良好,Ⅱ~Ⅳ级为预后不良。用多因素logistic回归分析检验影响癫痫预后的影响因素;受试者工作特征(ROC)曲线分析术前癫痫发作频率预测癫痫预后的价值。结果80例中,术后癫痫预后良好59例,预后不良21例。多因素logistic回归分析结果显示,异柠檬酸脱氢酶(IDH)1突变和术前癫痫发作频率高是胶质瘤病人术后癫痫的独立危险因素(P<0.05),全切肿瘤和术后化疗是保护性因素(P<0.05)。术前癫痫发作频率预测癫痫预后的ROC曲线下面积为0.805(95%置信区间0.685~0.914;P<0.05);当术前癫痫发作频率≥2次/月时,预测术后癫痫预后不良的灵敏度和特异度分别为92.86%和46.85%。结论IDH1突变和术前癫痫发作频率高是合并癫痫的幕上低级别胶质瘤病人癫痫预后不良的危险因素,而肿瘤全切除和术后化疗明显改善癫痫预后。

Risk factors for epilepsy prognosis in patients with supratentorial low-grade gliomas associated with epilepsy

Objective To explore the risk factors for epilepsy prognosis in the patients with supratentorial low-grade glioma associated with epilepsy. Methods The clinical data of 80 patients with supratentorial low-grade glioma associated with epilepsy who underwent microsurgery from June 2015 to January 2019 were retrospectively analyzed. One year after the surgery, Engel grade was used to evaluate the prognosis of epilepsy, with Engel grade I as a good prognosis and grade Ⅱ ~ Ⅳ as a poor prognosis. Multivariate logistic regression analysis was used to test the risk factors for epilepsy prognosis. Receiver operating characteristic (ROC) curve was used to analyze the value of preoperative seizure frequency to predict the epilepsy prognosis. Results Of these 80 patients, 59 patients had good prognosis and 21 had poor prognosis. Multivariate logistic regression analysis showed that isocitrate dehydrogenase (IDH) 1 mutation and high frequency of preoperative seizures were independent risk factors for poor epilepsy prognosis (P<0.05), and total resection of the tumor and postoperative chemotherapy were protective factors (P<0.05). The ROC curve analysis results showed that area under curve was 0.805 (95% confidence interval 0.685~0.914; P<0.05) for the preoperative seizure frequency to predict the epilepsy prognosis. When the preoperative seizure frequency ≥2 times per month, the sensitivity and specificity were 92.86% and 46.85%, respectively. Conclusions IDH1 mutation and high frequency of preoperative seizures are risk factors for poor prognosis of epilepsy in patients with supratentorial low-grade glioma associated with epilepsy. Total tumor resection and postoperative chemotherapy significantly improve the prognosis of epilepsy