Bussière Miguel, Hopman Wilma, Day Andrew, Pombo Alicia Paris, Neves Teresa, Espinosa Francisco
Department of Clinical Neurological Sciences, London Health Sciences of Western Ontario, Canada.
Can J Neurol Sci. 2005 Feb;32(1):50-6. doi: 10.1017/s0317167100016875.
We compared the functional status and survival time of patients with malignant gliomas.
This retrospective review included 143 patients diagnosed with malignant gliomas. Patients were grouped according to histopathological diagnosis. To measure functional status, patients were assigned a Karnofksy performance status (KPS) score at the time of presentation and at one, three, six, nine, 12 months and yearly intervals thereafter. Data were analyzed using descriptive methods as well as Kruskal-Wallis tests, Chi-square tests, Log-Rank tests and Cox's proportional hazards modeling.
Eighty-four patients were male. The median age of patients was 63 years. One hundred and seven patients had a histopathological diagnosis of glioblastoma multiforme, 23 of anaplastic astrocytoma and 13 of anaplastic oligodendroglioma. Twenty-nine patients received aggressive multimodal treatment, 83 received intermediate treatment and the remaining 31 patients received conservative therapy. Significant treatment complications occurred in 33% of patients including four post-operative deaths. The anaplastic oligodendroglioma group had lower mortality and maintained better KPS scores over time, as did patients receiving full treatment. The most significant prognostic factors for functional status included age, pretreatment KPS, and type of treatment received. The most significant factors associated with time until death included age, severity of comorbidities, pretreatment KPS, presence of confusion, histopathological diagnosis and type of treatment received.
In patients with malignant gliomas, younger age, better functional status at presentation and aggressive multimodal treatment were associated with improved longer-term functional status and survival. Confirmation of the effect of multimodal treatment on patient functional status would require a randomised controlled clinical trial.
我们比较了恶性胶质瘤患者的功能状态和生存时间。
这项回顾性研究纳入了143例被诊断为恶性胶质瘤的患者。患者根据组织病理学诊断进行分组。为了测量功能状态，在患者就诊时、之后1个月、3个月、6个月、9个月、12个月及此后每年对其进行卡氏功能状态评分（KPS）。使用描述性方法以及Kruskal-Wallis检验、卡方检验、对数秩检验和Cox比例风险模型对数据进行分析。
84例患者为男性。患者的中位年龄为63岁。107例患者的组织病理学诊断为多形性胶质母细胞瘤，23例为间变性星形细胞瘤，13例为间变性少突胶质细胞瘤。29例患者接受了积极的多模式治疗，83例接受了中度治疗，其余31例患者接受了保守治疗。33%的患者出现了严重的治疗并发症，包括4例术后死亡。间变性少突胶质细胞瘤组的死亡率较低，并且随着时间的推移保持了较好的KPS评分，接受全面治疗的患者也是如此。功能状态最重要的预后因素包括年龄、治疗前KPS以及接受的治疗类型。与死亡时间相关的最重要因素包括年龄、合并症严重程度、治疗前KPS、是否存在意识模糊、组织病理学诊断以及接受的治疗类型。
在恶性胶质瘤患者中，年龄较轻、就诊时功能状态较好以及积极的多模式治疗与长期功能状态改善和生存时间延长相关。要证实多模式治疗对患者功能状态的影响，需要进行一项随机对照临床试验。
