论文部分内容阅读
目的评估磁共振波谱分析(MRS)结合荧光素钠(FL)导航切除位于幕上的高级别胶质瘤(HGG)的临床效果。方法回顾性分析2013年8月至2015年11月在山东大学齐鲁医院经手术病理确诊的72例幕上HGG(WHOⅢ~Ⅳ级)患者的临床资料,分为MRS联合术中FL导航组(观察组,n=43)和显微外科手术组(对照组,n=29)两组。所有患者术前及术后第24~48 h均行MRI增强检查,比较两组患者的肿瘤切除程度。术后均行同步放化疗,采用Karnofsky(KPS)评分评价患者术后6个月的生存质量,观察患者术后1年的生存率和肿瘤无进展生存时间(PFS)。结果观察组患者的肿瘤完全切除(GTR)率显著高于对照组(72.09%比51.72%;χ~2=23.88,P=0.001),观察组中WHOⅣ级患者的肿瘤GTR率显著高于WHOⅢ级(92.86%比62.07%;χ~2=6.06,P=0.042)。观察组术后6个月的KPS评分显著高于对照组(μ=2.34,P=0.021)。平均随访(16.4±2.4)个月(8~21个月),观察组和对照组患者的1年生存率(74.07%比77.50%;χ2=4.90,P=0.165)和PFS[(13.2±1.2)个月比(12.7±2.0)个月;χ~2=7.26,P=0.067]差异均无统计学意义。两组中WHOⅣ级患者的1年生存率(71.43%比72.54%;χ~2=5.33,P=0.089)差异无统计学意义;观察组WHOⅣ级患者的PFS明显高于对照组[(14.2±0.3)个月比(10.0±1.1)个月;χ~2=11.03,P=0.031]。两组中WHOⅢ级患者的1年生存率(75.86%比72.22%;χ~2=3.78,P=0.250)和PFS[(13.7±1.4)个月比(12.4±0.8)个月;χ~2=4.85,P=0.083]差异均无统计学意义。结论 MRS联合术中FL导航技术能在保护神经功能前提下提高幕上HGG切除率,改善患者生存质量,目前没有发现延长肿瘤生存期的证据,但随样本量和随访时间增加,可能会观察到不同的预后指标。
Objective To evaluate the clinical effect of magnetic resonance spectroscopy (MRS) combined with sodium fluorescein (FL) navigation in the removal of high grade glioma (HGG) located on the supratentorial surface. Methods The clinical data of 72 patients with supratentorial HGG (WHO Ⅲ ~ Ⅳ grade) diagnosed by surgery and pathology from Qilu Hospital of Shandong University from August 2013 to November 2015 were retrospectively analyzed. They were divided into FLS navigation group (observation group Group, n = 43) and microsurgery group (control group, n = 29). All patients underwent MRI enhancement before and 24 to 48 hours after operation, and the degree of tumor resection was compared between the two groups. Postoperative concurrent chemoradiotherapy was performed. The Karnofsky (KPS) score was used to evaluate the patients’ quality of life at 6 months after operation. The 1-year postoperative survival rate and tumor progression-free survival time (PFS) were observed. Results The rate of tumor resection (GTR) in the observation group was significantly higher than that in the control group (72.09% vs. 51.72%; χ ~ 2 = 23.88, P = 0.001) (92.86% vs. 62.07%; χ ~ 2 = 6.06, P = 0.042). The KPS score of observation group at 6 months after operation was significantly higher than that of control group (μ = 2.34, P = 0.021). The average 1-year survival rate (74.07% vs 77.50%; χ2 = 4.90, P = 0.165) and PFS [(13.2 ± 1.2)% in the observation group and the control group were respectively followed up for 16.4 ± 2.4 months ) Months (12.7 ± 2.0) months; χ ~ 2 = 7.26, P = 0.067] There was no significant difference between the two groups. There was no significant difference in one-year survival rate (71.43% vs 72.54%; χ ~ 2 = 5.33, P = 0.089) between the two WHO and WHOⅣgroups. The PFS of the WHO Ⅳ patients in the observation group was significantly higher than that in the control group [(14.2 ± 0.3) months (10.0 ± 1.1) months; χ ~ 2 = 11.03, P = 0.031]. The 1-year survival rate (75.86% vs 72.22%; χ ~ 2 = 3.78, P = 0.250) and PFS [(13.7 ± 1.4) months vs (12.4 ± 0.8) months) = 4.85, P = 0.083] There was no significant difference. CONCLUSIONS: MRS combined with intraoperative FL navigation technique can improve supratentorial HGG resection rate and improve patient’s quality of life under the premise of protecting neurological function. No evidence of prolonging tumor survival has been found yet. However, with the increase of sample size and follow-up time, it may be observed Different prognostic indicators.