Huang J, Li M X, Ma M L, Ren X H, Cui Y, Lin S
Department of Neurosurgery, Linyi Central Hospital, Linyi 276000, Shandong Province, China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
Zhonghua Wai Ke Za Zhi. 2020 Jun 1;58(6):469-474. doi: 10.3760/cma.j.cn112139-20191209-00599.
To analyze the prognosis factors of cerebrospinal fluid (CSF) spread after surgery in glioblastoma (GBM) patients when tumors progressed and the effect factors on prognosis. A retrospective study was conducted on 124 patients who were pathologically diagnosed as glioblastoma after surgery, and found tumor progressed during regularly follow-up at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University between January 2009 and August 2017.There were 82 males and 42 females, aged 47.9 years(range: 19 to 75 years) .Patients were divided into local recurrence group(96 cases) and CSF spread group (28 cases) .Clinical data were recorded in detail and compared by independent sample test or χ(2) test.Kaplan-Meier survival curves was used to demonstrated the distribution of progression free survival (PFS) overall survival (OS) and post progression survival (PPS), and differences between local recurrence and CSF spread groups were assessed by Log-rank test.Cox proportion hazard regression analysis was used to identify independent prognostic factors. Logistics regression analysis showed ventricle entry was the only prognosis factor of CSF spread (2.667, 95: 1.128 to 6.304, 0.025).No significant distinction was observed in PFS between CSF spread group and local recurrence group(7.0 months .9.3 months, 0.066).However, OS and PPS were substantially shortened in CSF spread group (13.0 months .23.0 months, 0.011; 6.0 months .11.0 months, 0.022, respectively).Mutations of isocitrate dehydrogenase gene, distant spread, gross-total resection, Ki-67 index>30% were independent prognostic factors of GBM patients. Ventricle entry is a prognosis factor for CSF spread, after which the median OS and PPS are markedly diminished.However, ventricle entry is not independent prognosis factor shortening survival.
分析胶质母细胞瘤（GBM）患者术后肿瘤进展时脑脊液（CSF）播散的预后因素及对预后的影响因素。对124例术后经病理诊断为胶质母细胞瘤且于2009年1月至2017年8月在首都医科大学附属北京天坛医院神经外科定期随访期间发现肿瘤进展的患者进行回顾性研究。其中男性82例，女性42例，年龄47.9岁（范围：19至75岁）。患者分为局部复发组（96例）和脑脊液播散组（28例）。详细记录临床资料，并通过独立样本检验或χ²检验进行比较。采用Kaplan-Meier生存曲线展示无进展生存期（PFS）、总生存期（OS）和进展后生存期（PPS）的分布情况，并通过对数秩检验评估局部复发组和脑脊液播散组之间的差异。采用Cox比例风险回归分析确定独立预后因素。逻辑回归分析显示脑室受累是脑脊液播散的唯一预后因素（2.667，95%置信区间：1.128至6.304，P = 0.025）。脑脊液播散组和局部复发组的PFS无显著差异（7.0个月对9.3个月，P = 0.066）。然而，脑脊液播散组的OS和PPS显著缩短（分别为13.0个月对23.0个月，P = 0.011；6.0个月对11.0个月，P = 0.022）。异柠檬酸脱氢酶基因突变、远处转移、全切除、Ki-67指数>30%是GBM患者的独立预后因素。脑室受累是脑脊液播散的预后因素，此后中位OS和PPS明显缩短。然而，脑室受累不是缩短生存期的独立预后因素。
