胶质母细胞瘤患者初诊时癫痫发作的预后相关性。
Prognostic relevance of epilepsy at presentation in glioblastoma patients.
作者信息
Berendsen Sharon, Varkila Meri, Kroonen Jérôme, Seute Tatjana, Snijders Tom J, Kauw Frans, Spliet Wim G M, Willems Marie, Poulet Christophe, Broekman Marike L, Bours Vincent, Robe Pierre A
机构信息
Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, Netherlands (S.B., M.V., J.K., T.S., T.J.S., F.K., M.L.B., P.A.R.); Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands (W.G.M.S.); Department of Human Genetics, GIGA Research Center, University of Liège, Liège, Belgium (M.W., C.P., V.B., P.A.R.).
出版信息
Neuro Oncol. 2016 May;18(5):700-6. doi: 10.1093/neuonc/nov238. Epub 2015 Sep 29.
BACKGROUND
Epileptogenic glioblastomas are thought to convey a favorable prognosis, either due to early diagnosis or potential antitumor effects of antiepileptic drugs. We investigated the relationship between survival and epilepsy at presentation, early diagnosis, and antiepileptic drug therapy in glioblastoma patients.
METHODS
Multivariable Cox regression was applied to survival data of 647 consecutive patients diagnosed with de novo glioblastoma between 2005 and 2013 in order to investigate the association between epilepsy and survival in glioblastoma patients. In addition, we quantified the association between survival and valproic acid (VPA) treatment.
RESULTS
Epilepsy correlated positively with survival (HR: 0.75 (95% CI: 0.61-0.92), P < .01). This effect is independent of age, sex, performance status, type of surgery, adjuvant therapy, tumor location, and tumor volume, suggesting that this positive correlation cannot be attributed solely to early diagnosis. For patients who presented with epilepsy, the use of the antiepileptic drug VPA did not associate with survival when compared with patients who did not receive VPA treatment.
CONCLUSION
Epilepsy is an independent prognostic factor for longer survival in glioblastoma patients. This prognostic effect is not solely explained by early diagnosis, and survival is not associated with VPA treatment.
背景
致痫性胶质母细胞瘤被认为预后较好，这可能是由于早期诊断或抗癫痫药物的潜在抗肿瘤作用。我们研究了胶质母细胞瘤患者就诊时癫痫与生存、早期诊断及抗癫痫药物治疗之间的关系。
方法
对2005年至2013年间连续诊断为原发性胶质母细胞瘤的647例患者的生存数据进行多变量Cox回归分析，以研究胶质母细胞瘤患者癫痫与生存之间的关联。此外，我们还量化了生存与丙戊酸（VPA）治疗之间的关联。
结果
癫痫与生存呈正相关（风险比：0.75（95%置信区间：0.61-0.92），P <.01）。这种效应独立于年龄、性别、功能状态、手术类型、辅助治疗、肿瘤位置和肿瘤体积，这表明这种正相关不能仅仅归因于早期诊断。对于有癫痫症状的患者，与未接受VPA治疗的患者相比，使用抗癫痫药物VPA与生存无关。
结论
癫痫是胶质母细胞瘤患者生存时间延长的独立预后因素。这种预后效应不能仅仅用早期诊断来解释，且生存与VPA治疗无关。
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