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背景与目的:影响手术后低级别星形细胞胶质瘤预后的因素很多,对其治疗方式的选择仍有较多争议,判断预后的因素也不尽一致。本研究探讨低级别星形细胞瘤的临床相关因素与预后的关系,为脑胶质瘤的治疗选择提供理论依据。方法:应用Cox风险比例模型,行逐步回归分析研究2001年至2006年间确诊的123例低级别星形细胞瘤患者的性别、年龄、术前症状、KPS评分、发病至就诊时间、肿瘤部位、肿瘤大小、手术切除程度及术后放疗对生存时间的影响。结果:多因素分析示,术前有癫痫症状者生存时间较长(P<0.05),术前有缺失症状(P=0.002)及发病至就诊时间短的患者(P=0.012)生存时间显著缩短。手术切除程度对生存时间无显著影响,对于术后放疗,共有51例患者(41.5%)行术后放疗,剂量在40～60Gy,无论单因素或多因素分析,其对生存时间均无显著影响(P=0.14)。结论:对于低级别星形细胞瘤,术前癫痫症状预示相对预后较好,手术切除程度及术后放疗对生存时间无明显影响。
BACKGROUND & OBJECTIVE: There are many factors influencing the prognosis of low-grade astrocytic gliomas after surgery. There are still many controversies about the choice of treatment modalities, and the prognostic factors are not all the same. This study was to investigate the relationship between clinical factors and prognosis of low-grade astrocytomas and to provide a theoretical basis for the treatment of gliomas. Methods: Cox proportional hazard model was used to analyze the gender, age, preoperative symptoms, KPS score, onset to treatment time, tumor location, tumor location and prognosis of 123 patients with low grade astrocytoma diagnosed between 2001 and 2006 using stepwise regression analysis. Size, degree of surgical resection and postoperative radiotherapy on the survival time. Results: Multivariate analysis showed that patients with preoperative epilepsy had longer survival time (P <0.05), preoperative loss of symptoms (P = 0.002), and shorter duration of illness (P = 0.012) . The degree of surgical resection had no significant effect on the survival time. For postoperative radiotherapy, 51 patients (41.5%) underwent postoperative radiotherapy at a dose of 40-60 Gy, which had no significant effect on survival time, regardless of univariate or multivariate analysis (P = 0.14). Conclusion: For low-grade astrocytomas, the preoperative epilepsy symptoms indicate that the relative prognosis is good. The degree of surgical resection and postoperative radiotherapy have no significant effect on the survival time.