岛叶胶质母细胞瘤的临床特征和预后影响因素分析

目的探讨岛叶胶质母细胞瘤的临床特征和影响预后的临床因素。方法回顾性分析2006年7月至2013年6月中国脑胶质瘤基因组图谱计划(CGGA)数据库中44例岛叶胶质母细胞瘤患者的临床资料。所有患者均行肿瘤切除术,术后27例接受放、化疗联合治疗,另17例未接受。总结所有患者的临床特征,包括是否存在癫痫发作史、异柠檬酸脱氢酶1(IDH1)突变、O6-甲基鸟嘌呤-DNA-甲基转移酶(MGMT)甲基化、肿瘤强化情况及临床分型等。采用Kaplan-Meier法分析所有患者的无进展生存期(PFS)和总生存期(OS)。进一步采用多因素Cox回归分析方法探讨影响患者PFS和OS的临床因素。结果44例患者中,33例(75.0%)存在癫痫发作史,11例(25.0%)为IDH1突变型,19例(43.2%)存在MGMT甲基化,42例(95.5%)存在肿瘤强化。Yasargil分型:2例为3A型,27例为3B型,15例为5A/B型;Saito分型:2例局限于岛叶皮质内,9例经前环岛沟向额叶侵袭,16例经下环岛沟向颞叶侵袭,17例经2个以上环岛沟向多方侵袭;Moshe分型:35例对豆纹动脉形成包绕或侵袭,余9例未侵袭;壳核分型:38例对壳核不同程度的侵袭,余6例未累及。Kaplan-Meier法分析结果显示,所有患者的中位PFS为278 d,中位OS为435 d。多因素Cox回归分析结果显示,肿瘤体积小于中位数(HR=0.390,95%CI:0.189~0.802,P=0.011)、IDH1突变(HR=0.391,95%CI:0.175~0.876,P=0.023)及术后放、化疗联合治疗(HR=0.346,95%CI:0.162~0.738,P=0.006)是影响患者PFS的独立保护因素;而MGMT甲基化(HR=0.371,95%CI:0.181~0.758,P=0.007)、肿瘤切除程度≥90%(HR=0.412,95%CI:0.194~0.875,P=0.021)及术后接受放、化疗联合治疗(HR=0.347,95%CI:0.170~0.708,P=0.004)是影响患者OS的独立保护因素。结论岛叶胶质母细胞瘤对脑深部重要的神经血管结构具有很强的侵袭性,手术切除难度大,预后差;最大程度切除肿瘤并规范放、化疗可改善患者的预后。

Clinical characteristics and prognostic factors of insular glioblastomas

Objective To explore the clinical characteristics and prognostic factors of insular glioblastomas.Methods Clinical data of 44 patients with insular glioblastomas in Chinese Glioma Genome Atlas(CGGA)databases from July 2006 to June 2013 were evaluated.All patients underwent tumor resection.Among them,27 underwent adjuvant radiochemotherapy and 17 underwent no postoperative adjuvant therapy.Progression-free survival(PFS)and overall survival(OS)of all patients were analyzed by Kaplan-Meier method.Furthermore,multivariate Cox regression analysis was used to investigate the prognostic clinical factors.Results In a total of 44 patients,33(75.0%)had a history of epileptic seizure,11(25.0%)had isocitrate dehydrogenase 1(IDH1)mutation,19(43.2%)had O6-methy-lguanine-DNA-methyltransferase(MGMT)methylation,and 42(95.5%)had tumor enhancement.Based on Yasargil′s classification,there were type 3A in 2 cases,type 3B in 27 cases and type 5A/B in 15 cases.Based on Saito′s classification,there were 2 cases confined to the insular cortex,9 cases with invasion to the frontal lobe via the anterior circumferential sulcus,16 cases with invasion to the temporal lobe via the lower circumferential sulcus,and 17 cases with invasion to multiple directions via more than 2 circumferential sulci.Based on Moshe′s classification,there were 35 cases with envelopment or invasion of the lenticulostriate artery,while no invasion was reported in the remaining 9 cases.Based on the putamen classification,there were 38 cases with various degrees of putamen invasion,and the remaining 6 cases had no involvement of the putamen.Kaplan-Meier curve showed that the median PFS of all patients was 278 d and the median OS was 435 d.Multivariate Cox regression analysis showed that tumor volume