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目的探讨初诊MRI影像特征及术后放疗、化疗对大脑半球高级别胶质瘤全切术后无进展生存期(progression-free survival,PFS)的影响。方法回顾性分析4个临床中心的54例影像学确定全切除又经病理证实复发或临床随访判断为进展的高级别胶质瘤的初诊MRI影像特征(包括肿瘤最大径、瘤周水肿特征、肿瘤增强程度、坏死程度、囊性变与否及是否存在卫星灶)及术后辅助放化疗情况。单因素采用Kaplan-Meier法、多因素使用Cox比例风险模型等统计方法研究这些因素与PFS的相关性。结果单因素分析显示:年龄(P=0.009)、瘤周水肿程度(P=0.001)、肿瘤坏死程度(P<0.0001)、肿瘤强化程度(P<0.0001)、术后放疗(P=0.008)、化疗(P=0.035)与肿瘤PFS相关。多因素分析结果显示:水肿程度(P=0.019)、肿瘤坏死程度(P<0.0001)为影响肿瘤PFS的独立因素且水肿和坏死程度越轻其PFS越长、术后放疗(P=0.035)、化疗(P=0.049)也为影响肿瘤PFS的独立因素且规放化疗PFS较长。结论术前MRI影像瘤周水肿程度及肿瘤坏死程度可用于评估胶质瘤全切术后PFS,大脑半球高级别脑胶质瘤即使在影像学上全切,术后也应提倡积极、规范的放疗和化疗。
Objective To explore the characteristics of newly diagnosed MRI and the effect of postoperative radiotherapy and chemotherapy on progression-free survival (PFS) after total resection of high-grade gliomas in the hemisphere. Methods A retrospective analysis was performed on 54 newly diagnosed, high-grade gliomas diagnosed by total resection, pathological confirmed recurrence or clinical follow-up in 54 clinical centers. The features of newly diagnosed high grade gliomas including maximum diameter of tumor, characteristics of peritumoral edema, Degree of enhancement, degree of necrosis, cystic degeneration or whether there is a satellite or not) and postoperative adjuvant radiotherapy and chemotherapy. Kaplan-Meier single-factor method, multi-factor Cox proportional hazards model and other statistical methods to study the correlation between these factors and PFS. Results Univariate analysis showed that age (P = 0.009), degree of peritumoral edema (P = 0.001), tumor necrosis (P <0.0001), degree of tumor enhancement (P <0.0001), postoperative radiotherapy Chemotherapy (P = 0.035) was associated with tumor PFS. Multivariate analysis showed that the degree of edema (P = 0.019), the degree of tumor necrosis (P <0.0001) were the independent factors affecting the PFS of the tumor. The lighter edema and necrosis were, the longer the PFS was, the longer the postoperative radiotherapy was (P = 0.035) Chemotherapy (P = 0.049) was also an independent factor affecting tumor PFS with longer PFS. Conclusions The degree of peritumoral edema and the degree of tumor necrosis in preoperative MRI can be used to evaluate the PFS after total gliomas. Even if the high grade gliomas in the cerebral hemispheres are completely resected in the imaging, postoperative positive and standard Radiotherapy and chemotherapy.