上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

胶质瘤复发的病理特征及手术疗效分析

侯艳丽1，2，白永瑞2，陈海燕2，黄仁华2，叶明2，张伟伟1，冯海忠1   

  1. 上海交通大学 医学院附属仁济医院 1.仁济-Med X临床干细胞研究中心， 2.放疗科， 上海200127
  • 出版日期:2015-09-28 发布日期:2015-09-30
  • 通讯作者: 冯海忠, 电子信箱: fenghaizhong@sjtu.edu.cn。
  • 作者简介:侯艳丽（1972—）， 女， 主治医师， 学士; 电子信箱: hylrj@126.com。
  • 基金资助:

    国家自然科学基金（81372704, 81572764）; 上海高校特聘教授（东方学者）

Analysis of pathologic features of recurrent gliomas and therapeutic effect of surgery

HOU Yan-li1，2, BAI Yong-rui2, CHEN Hai-yan2, HUANG Ren-hua2, YE Ming2, ZHANG Wei-wei1,  FENG Hai-zhong1   

  1. 1.Renji-Med X Clinical Stem Cell Research Center, 2.Department of Radiotherapy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200127, China
  • Online:2015-09-28 Published:2015-09-30
  • Supported by:

    National Natural Science Foundation of China， 81372704, 81572764; Program for Professor of Special Appointment (Eastern Scholar) at Shanghai Institutions of Higher Learning

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摘要：

目的  初步探讨胶质瘤复发的病理特征改变及手术的临床意义。方法  回顾性分析2004年1月—2014年1月在上海交通大学医学院附属仁济医院神经外科复发后手术治疗的13例脑胶质瘤患者，比较不同级别胶质瘤复发的病理特征改变及预后。 结果  53.8%（7/13）患者出现病理升级，38.5%（5/13）患者病理级别未改变，7.7%（1/13）患者出现降级。复发患者手术后中位生存时间为28个月（2～63个月），1年生存率为52%，2年生存率为42%。单因素分析显示：复发时病理类型、2次手术间隔＞12个月，初发时磷酸酯酶与张力蛋白同源物 (PTEN）复发时p53、Ki-67表达与患者总生存时间显著相关（P<0.05）。而多因素分析显示：复发时病理类型为复发胶质瘤患者生存的独立预后因素（P=0.031）。结论  大部分患者复发时出现病理升级，手术仍能带来生存获益。

关键词: 胶质瘤, 复发, 手术, 预后

Abstract:

Objective  To explore the pathological changes of recurrent gliomas and the clinical value of operation. Methods  A total of 13 patients with recurrent brain gliomas who underwent surgical treatment at the Department of Neurosurgery of Renji Hospital of Shanghai Jiao Tong University School of Medicine between January 2004 and January 2014 were retrospectively analyzed. The pathological changes of different grades of recurrent gliomas and the prognosis were compared. Results  Among all patients, 7 of them (53.8%) pathologically upgraded, 5 of them (38.5%) remained the same, and one patient (7.7%) pathologically degraded. The median survival time of patients was 28 months (2-63 months), 1 year survival rate was 52%, and 2 year survival rate was 42%. Univariate analysis showed that the pathological level of recurrent gliomas, time between two operations＞12 months, expressions of phosphatase and tensin homolog deleted on chromosome ten (PTEN) of patients with primary gliomas, and expressions of p53 and Ki-67 of patients with recurrent gliomas were closely correlated with the overall survival time of patients (P<0.05). Multivariate analysis suggested that the pathological level of recurrent gliomas was the independent prognostic factor for the survival of patients (P=0.031). Conclusion  Most patients with recurrent gliomas pathologically upgrade and operation is helpful for the survival of patients.

Key words: gliomas, recurrence, operation, prognosis