脑胶质瘤病人的预后多因素生存分析与相关性研究

目的研究影响脑胶质瘤病人生存和预后的相关因素,以及相关因素之间的相关性。方法 2005年1月-2009年6月在河北医科大学第二医院神经外科住院及接受手术治疗的脑胶质瘤患者79例,对其年龄、性别、术前KPS评分、发病至就诊时间、术前抽搐、肿瘤直径、肿瘤术中切除范围、肿瘤病理分级、术后放疗、术后化疗、肿瘤分子标志物如多发性进展期癌突变基因(PTEN)、抑癌基因P53、增殖细胞核抗原(PCNA)、DNA修复蛋白O6-甲基鸟嘌呤DNA甲基转移酶(MGMT)、基质金属蛋白酶9(MMP-9)及多药耐药基因(P170)的表达情况共16项因素进行生存分析。对肿瘤级别、肿瘤分子标志物之间的相关性使用Spearman相关性检验进行分析。结果单因素分析结果示:术前KPS评分、发病至就诊时间、术前抽搐、肿瘤切除范围、肿瘤病理分级、术后放疗、术后化疗、MMP-9的表达情况具有统计学意义。多因素分析结果示:术前KPS评分≥70的患者生存时间较长(P=0.047),术前有抽搐症状的患者生存时间较长(P=0.025),术中全切的患者生存时间较长(P=0.037),术后结合化疗的患者生存时间较长(P=0.005)。相关性分析结果显示:肿瘤级别与PCNA的表达情况呈正相关(r=0.250,P=0.027),PTEN与P170在胶质瘤的表达情况中成负相关(r=-0.252,P=0.025),MMP-9与P170在胶质瘤的表达情况中成正相关(r=0.382,P=0.001)。结论胶质瘤患者术前KPS评分≥70、术前有抽搐症状、肿瘤术中全切、术后结合化疗的患者生存时间较长,是脑胶质瘤患者预后较好的有利因素。

Multivariate analysis of prognostic factors in 79 patients with glioma and correlations of some factors

Objective To study the survival and prognostic factors of the patients with glioma and the correlations of some factors. Methods To review the data of 79 patients with glioma treated in the Second Hospital of Hebei Medical University and analyze 16 possible factors selected. Besides, linear relationship analysis with Spearman correlation coefficients was used to study the correlations of some factors. Results Following a univariate regression analysis, good preoperative neurological status, longer duration of symptoms, having epilepsy before operation, macroscopically total resection, lower pathological grade, postoperative chemotherapy and lower expression of MMP-9 were associated with better overall survival rates. Multivariate Cox regression analysis found that KPS, duration of symptoms, having epilepsy before operation, extent of resection, and postoperative chemotherapy were independent prognostic factors influencing the survival. Firstly in linear relationship analysis, pathological grade was related to the expression of PCNA, and the correlation coefficient was 0.250（P=0.027）.Secondly, the expression of PTEN was also related to the expression of P170, but the correlation coefficient was -0.252 （P=0.025）. Thirdly, the expression of P170 was also related to the expression of MMP-9, and the correlation coefficient was 0.382 （P=0.001）. Conclusion KPS≥70, having epilepsy before operation, macroscopically total resection and postoperative chemotherapy are better independent prognostic factors.