继发性胶质母细胞瘤的预后影响因素研究

目的探讨影响继发性胶质母细胞瘤（sGBM）患者生存结局的临床预后因素。方法回顾性分析首都医科大学附属北京天坛医院2006年3月—2017年3月收治的125例sGBM患者的临床资料。临床特征和生存结果均从住院记录和随访记录中获得。应用单因素及多因素Cox回归和Kaplan-Meier生存分析，明确影响sGBM患者的独立预后因素。结果所有纳入患者的中位总生存期（OS）为301天。肿瘤全切（HR=0.613, 95% CI=0.408~0.923,P=0.019）；定期复查时诊断为无新发症状sGBM（HR=0.481,95% CI=0.308~0.750,P=0.001），较高的术后KPS（HR=0.977,95% CI=0.961~0.993,P=0.006）都是有利于OS的独立预后因素。肿瘤全切是无新发症状sGBM患者(HR=0.238, 95% CI=0.100~0.570,P=0.001) 和因新发神经功能障碍而诊断的sGBM患者（HR=0.410,95% CI=0.205~0.821,P=0.012）OS的有利预后因素。此外，术后KPS评分不降低对于因新发神经功能障碍而诊断的sGBM患者（HR=0.401,95% CI=0.202~0.795, P=0.009）和因新发癫痫而诊断的sGBM患者（HR=0.295, 95% CI=0.092~0.950,P=0.041）OS的有利预后因素。结论对于sGBM患者来说，肿瘤全切除、较高的术后KPS评分、诊断时无新发症状是OS的有利预后因素。

Objective To explore the clinical prognostic factors affecting the survival outcome of patients with secondary glioblastoma(sGBM). Methods The clinical data of 125 patients with sGBM admitted to the Beijing Tiantan Hospital, Capital Medical University from March 2006 to March 2017 were analyzed retrospectively. Clinical features and survival outcomes were obtained from hospitalization and follow-up records. The univariate and multivariate Cox regression and Kaplan Meier survival analysis were applied to identify independent prognostic factors affecting sGBM patients. Results Median overall survival(OS) was 301 days, and median PFS was 208 days in patients with sGBM. Gross total resection(P=0.011, HR=0.585, 95% CI from 0.721 to 1.787), incidental diagnosis(regular re-examination without any symptoms) (P=0.040, HR=0.587, 95% CI=0.354-0.975), with preoperative epilepsy(P=0.024, HR=0.529, 95% CI=0.305-0.919) were independently favorable prognosis factors for OS. Gross total resection(P=0.014, HR=0.559, 95% CI=0.368-0.891), without any neurological deficits(P=0.019, HR=0.580, 95% CI=0.435-0.975), and higher postoperative Karnofsky Performance Status score(P=0.011, HR=0.974, 95% CI=0.954-0.994) were independently favorable prognosis factors for PFS. Conclusion For patients with sGBM, total resection, high postoperative KPS and no new symptons at diagnosis are favorable prognostic factors for OS.