成人幕上低級別膠質瘤（WHO Ⅱ級）患者術后生活質量相關因素評估_《華西醫學》

作者：

董曉書 , 王翔 , 劉艷輝 , 劉雙 ,  毛慶

四川大學華西醫院神經外科（成都，610041）;

關鍵詞：

神經膠質瘤 Karnofsky評分術后評估

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【摘要】　目的　探討成人幕上低級別膠質瘤（WHO Ⅱ級）患者術后生活質量的影響因素。　方法　回顧性分析2008年10月—2010年5月經手術切除病變、術后病理證實為低級別膠質瘤的115例患者臨床資料，術后隨訪6~24個月。以患者年齡、性別、主要臨床癥狀、病變部位、病變大小及病理結果為自變量，以術后Karnofsky評分（KPS）改善為因變量，采用Logistic回歸分析研究相關影響因素。采用秩和檢驗比較不同組間KPS差異。　結果　隨訪至術后6個月，患者年齡、病變大小、病變部位、切除范圍以及是否有癲癇史在KPS比較中，其結果有統計學意義（P lt;0.05）。隨訪至術后12個月，切除范圍和癲癇史對KPS評分已無影響（P gt;0.05）。病理類型、術前是否存在神經功能障礙與術后KPS改善在單因素和多因素比較中無統計學意義。　結論　患者年齡≤50歲、術前有癲癇史、腫瘤直徑≤4 cm、病變表淺、腫瘤全切除的患者術后KPS改善好于年齡 gt;50歲、術前無癲癇史、腫瘤直徑 gt;4 cm、病變深在、腫瘤次全切除的患者。患者術前是否存在神經功能障礙和病理類型與術后生活質量是否改善無明顯關系。復發也是影響患者術后KPS改善的因素。
【Abstract】　Objective　 To assess the quality of life in adults with surgically managed cerebral supratentorial low grade glioma (WHO grade Ⅱ) and the relevant factors. 　Methods　 We retrospectively analyzed the clinical data of 115 patients with histologically proven supratentorial low grade glioma enrolled at West China Hosptial from October 2008 to May 2010. Follow-up lasted for 6 to 24 months after operation. Logisitc regression analysis is used to test the relevant factors with age, gender, main clinical manifestations, lesion location, lesion size and pathological results as the independent variables, and Kamofsky postoperative scale (KPS) scores as dependent variable. KPS scores of different groups were analyzed using the rank test. 　Results　 After 6 months of follow-up, we found that age, size, location, extent of surgical excision and eplispy history showed a statistical significance in KPS comparison (P lt;0.05). Till the 12th month in the follow-up, the extent of surgical excision and eplispy history were not statistically significant any more (P gt;0.05). Histology type and neurological deficit had no relationship with KPS improvement in both single factor analysis and multivariate analysis. 　Conclusions　 Patients with an age older than 50 years, preoperative epilepsy history, the largest diameter of the tumor less than 4 cm, shallow lesions, and complete tumor resection have a better KPS improvement after operation than those with corresponding opposite conditions. There is no obvious relationship between histology type, neurologic deficits and KPS improvement after operation. Recurrence is also a factor influencing KPS improvement after operation.

引用本文： 董曉書,王翔,劉艷輝,劉雙,毛慶. 成人幕上低級別膠質瘤（WHO Ⅱ級）患者術后生活質量相關因素評估. 華西醫學, 2011, 26(5): 674-678. doi: 復制

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2.	Nicolato A, Gerosa MA, Fina P, et al. Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients[J]. Surg Neurol, 1995, 44(3): 208-223.
3.	Chang EF, Clark A, Jensen RL, et al. Multiinstitutional validation of the University of California at San Francisco Low-Grade Glioma Prognostic Scoring System[J]. J Neurosurg, 2009, 111(2): 203-210.
4.	張懋植. 成人低級別膠質瘤的治療進展[J]. 中國微侵襲神經外科雜志, 2006, 11(1): 78.
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8.	Aghi MK, Carter BS, Cosgrove GR, et al. Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation[J]. Neurosurgery, 2009, 64(1): 56-60.
9.	Pignatti F, van den Bent M, Curran D, et al. Prognostic factors for survival in adult patients with cerebral low-grade glioma[J]. J Clin Oncol, 2002, 20(8): 2076-2084.
10.	Scerrati M, Roselli R, Iacoangeli M, et al. Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery[J]. J Neurol Neurosurg Psychiatry, 1996, 61(3): 291-296.
11.	Shaw EG, Berkey B, Coons SW, et al. Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial[J]. J Neurosurg, 2008, 109(5): 835-841.
12.	Trojanowski T, Peszynski J, Turowski K, et al. Quality of survival of patients with brain gliomas treated with postoperative CCNU and radiation therapy[J]. J Neurosurg, 1989, 70(1): 18-23.
13.	Rezvan A, Christine D, Christian H, et al. Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients[J]. Acta Neurochir, 2009, 151(11): 1359-1365.
14.	Rudà R, Trevisan E, Soffietti R. Epilepsy and brain tumors[J]. Currt Opin Oncol, 2010, 22(6): 611-620.
15.	Mainio A, Hakko H, Niemel A, et al. Gender difference in relation to depression and quality of life among patients with a primary brain tumor[J]. Eur Psychiatry, 2006, 21(3): 194-199.
16.	Houillier C, Mokhtari K, Carpentier C, et al. Chromosome 9p and 10q losses predict unfavorable outcome in low-grade gliomas[J]. Neuro Oncol, 2010, 12(1): 2-6.
17.	Hartmann C, Meyer J, Balss J, et al. Type and frequency of IDH1 and IDH2 mutations are related to astrocytic and oligodendroglial differentiation and age: a study of 1, 010 diffuse gliomas[J]. Acta Neuropathologica, 2009, 118(4): 469-474.
18.	Hartmann C, Hentschel B, Wick W, et al. Patients with IDH1 wild type anaplastic astrocytomas exhibit worse prognosis than IDH1-mutated glioblastomas, and IDH1 mutation status accounts for the unfavorable prognostic effect of higher age: implications for classification of gliomas[J]. Acta Neuropathologica, 2010, 120(6): 707-718.

1. 　Pouratian N, Schiff D. Management of low-grade glioma[J]. Curr Neurol Neurosci Rep, 2010, 10(3): 224-231.
2. 　Nicolato A, Gerosa MA, Fina P, et al. Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients[J]. Surg Neurol, 1995, 44(3): 208-223.
3. 　Chang EF, Clark A, Jensen RL, et al. Multiinstitutional validation of the University of California at San Francisco Low-Grade Glioma Prognostic Scoring System[J]. J Neurosurg, 2009, 111(2): 203-210.
4. 　張懋植. 成人低級別膠質瘤的治療進展[J]. 中國微侵襲神經外科雜志, 2006, 11(1): 78.
5. 　Zalutsky MR, Zhao XG, Alston KL, et al. High-level production of alpha-particle-emitting (211) At and preparation of (211) At-labeled antibodies for clinical use[J]. J Nucl Med, 2001, 42(10): 1508-1515.
6. 　Walker DG, Kaye AH. Low grade glial neoplasms[J]. J Clin Neurosci, 2003, 10(1): 1213.
7. 　Wisoff JH, Boyett JM, Berger MS, et al. Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children’s Cancer Group trial no. CCG-945[J]. J Neurosurg, 1998, 89(1): 52-59.
8. 　Aghi MK, Carter BS, Cosgrove GR, et al. Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation[J]. Neurosurgery, 2009, 64(1): 56-60.
9. 　Pignatti F, van den Bent M, Curran D, et al. Prognostic factors for survival in adult patients with cerebral low-grade glioma[J]. J Clin Oncol, 2002, 20(8): 2076-2084.
10. 　Scerrati M, Roselli R, Iacoangeli M, et al. Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery[J]. J Neurol Neurosurg Psychiatry, 1996, 61(3): 291-296.
11. 　Shaw EG, Berkey B, Coons SW, et al. Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial[J]. J Neurosurg, 2008, 109(5): 835-841.
12. 　Trojanowski T, Peszynski J, Turowski K, et al. Quality of survival of patients with brain gliomas treated with postoperative CCNU and radiation therapy[J]. J Neurosurg, 1989, 70(1): 18-23.
13. 　Rezvan A, Christine D, Christian H, et al. Long-term outcome and survival of surgically treated supratentorial low-grade glioma in adult patients[J]. Acta Neurochir, 2009, 151(11): 1359-1365.
14. 　Rudà R, Trevisan E, Soffietti R. Epilepsy and brain tumors[J]. Currt Opin Oncol, 2010, 22(6): 611-620.
15. 　Mainio A, Hakko H, Niemel A, et al. Gender difference in relation to depression and quality of life among patients with a primary brain tumor[J]. Eur Psychiatry, 2006, 21(3): 194-199.
16. 　Houillier C, Mokhtari K, Carpentier C, et al. Chromosome 9p and 10q losses predict unfavorable outcome in low-grade gliomas[J]. Neuro Oncol, 2010, 12(1): 2-6.
17. 　Hartmann C, Meyer J, Balss J, et al. Type and frequency of IDH1 and IDH2 mutations are related to astrocytic and oligodendroglial differentiation and age: a study of 1, 010 diffuse gliomas[J]. Acta Neuropathologica, 2009, 118(4): 469-474.
18. 　Hartmann C, Hentschel B, Wick W, et al. Patients with IDH1 wild type anaplastic astrocytomas exhibit worse prognosis than IDH1-mutated glioblastomas, and IDH1 mutation status accounts for the unfavorable prognostic effect of higher age: implications for classification of gliomas[J]. Acta Neuropathologica, 2010, 120(6): 707-718.

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成人幕上低級別膠質瘤（WHO Ⅱ級）患者術后生活質量相關因素評估

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《華西醫學》

成人幕上低級別膠質瘤（WHO Ⅱ級）患者術后生活質量相關因素評估

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