Buckner Jan C
Mayo Clinic, Rochester, MN, USA.
Semin Oncol. 2003 Dec;30(6 Suppl 19):10-4. doi: 10.1053/j.seminoncol.2003.11.031.
Multivariate analyses have consistently identified a number of patient, tumor, and treatment variables that are significant prognostic factors for overall survival in patients with high-grade glioma. Age, performance status, mental status, tumor grade and histology, and extent of surgical resection are among the most significant prognostic factors influencing survival. Recently, we showed that normal versus abnormal baseline Folstein mini-mental status examination score is a significant prognostic factor in younger patients (age </=42), suggesting that mental status may be a more important determinant of clinical outcome than physical functioning in patients with high-grade glioma. Among tumor variables, tumor grade and histology appear to have the greatest effect on survival. A recursive partitioning analysis of three Radiation Therapy Oncology Group trials showed that among patients under 50 years of age, astrocytoma with anaplastic or atypical foci was associated with significantly improved survival compared with glioblastoma. An oligodendroglial component was also associated with improved survival in patients with grade 3 astrocytoma. In addition, combined loss of chromosome arms 1p and 19q is associated with improved chemosensitivity and overall survival in patients with pure oligodendroglioma. Among the treatment variables tested, extent of resection appears to be the most consistent prognostic factor. Gross total resection is associated with significantly improved survival compared with biopsy only. These models are capable of grouping patients into distinct prognostic subgroups with median survivals ranging from less than 5 to more than 50 months and thus provide useful information for future clinical trial design.
多变量分析一直都确定了一些患者、肿瘤和治疗变量，这些变量是高级别胶质瘤患者总生存期的重要预后因素。年龄、体能状态、精神状态、肿瘤分级和组织学以及手术切除范围是影响生存的最重要的预后因素。最近，我们发现基线Folstein简易精神状态检查评分正常与异常是年轻患者（年龄≤42岁）的一个重要预后因素，这表明在高级别胶质瘤患者中，精神状态可能比身体功能对临床结局的决定作用更重要。在肿瘤变量中，肿瘤分级和组织学似乎对生存影响最大。对三项放射肿瘤学组试验进行的递归划分分析表明，在50岁以下的患者中，伴有间变或非典型病灶的星形细胞瘤与胶质母细胞瘤相比，生存期显著改善。少突胶质细胞成分也与3级星形细胞瘤患者的生存期改善有关。此外，1号染色体短臂和19号染色体长臂联合缺失与纯少突胶质细胞瘤患者化疗敏感性提高和总生存期延长有关。在测试的治疗变量中，切除范围似乎是最一致的预后因素。与仅行活检相比，全切除与生存期显著改善有关。这些模型能够将患者分为不同的预后亚组，中位生存期从不到5个月到超过50个月不等，从而为未来的临床试验设计提供有用信息。
