成人胶质母细胞瘤预后因素分析：单中心176例临床回顾

黄国浩; 曹勇勇; 杨林; 张作鑫; 向琰; 裴玉春; 李瑶; 陈伟; 吕胜青

doi:10.16016/j.2097-0927.202402039

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成人胶质母细胞瘤预后因素分析：单中心176例临床回顾

临床医学 | 更新时间：2026-01-09

- 成人胶质母细胞瘤预后因素分析：单中心176例临床回顾
- Prognostic factors for glioblastoma: a retrospective single-center analysis of 176 adults
- 陆军军医大学学报 2024年46卷第17期页码：2002-2008
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院神经外科
- 作者简介：
  
  [吕胜青，E-mail：lvsq0518@tmmu.edu.cn LYU Shengqing, E-mail: lvsq0518@tmmu.edu.cn
- 基金信息：
  
  国家自然科学基金青年项目(82103274);国家自然科学基金面上项目(81972360)
- DOI：10.16016/j.2097-0927.202402039
  中图分类号： R181.23;R730.264;R739.41
- 收稿：2023-02-18，
  
  修回：2024-04-09，
  
  纸质出版：2024-09-15
- 稿件说明：
移动端阅览
黄国浩, 曹勇勇, 杨林, 等. 成人胶质母细胞瘤预后因素分析：单中心176例临床回顾[J]. 陆军军医大学学报, 2024,46(17):2002-2008.

Guohao HUANG, Yongyong CAO, Lin YANG, et al. Prognostic factors for glioblastoma: a retrospective single-center analysis of 176 adults[J]. Journal of Army Medical University, 2024, 46(17): 2002-2008.
黄国浩, 曹勇勇, 杨林, 等. 成人胶质母细胞瘤预后因素分析：单中心176例临床回顾[J]. 陆军军医大学学报, 2024,46(17):2002-2008. DOI： 10.16016/j.2097-0927.202402039.

Guohao HUANG, Yongyong CAO, Lin YANG, et al. Prognostic factors for glioblastoma: a retrospective single-center analysis of 176 adults[J]. Journal of Army Medical University, 2024, 46(17): 2002-2008. DOI： 10.16016/j.2097-0927.202402039.

摘要

目的

探讨成人胶质母细胞瘤(glioblastomas，GBM)临床特点、治疗及预后情况。

方法

收集2015-2021年于我科诊治的176例小脑幕上GBM患者临床资料进行回顾性队列研究。采用

检验分析异柠檬酸脱氢酶(isocitrate dehydrogenase，IDH)野生型和突变型GBM临床特征，Kaplan-Meier和Log-rank方法绘制生存曲线及检验评估，多因素Cox危险度回归分析预后影响因素。

结果

本组患者IDH野生型GBM占比89.2%，其在发病年龄、入院KPS评分、神经功能受损症状、O

-甲基鸟嘌呤DNA甲基转移酶(O

-methylguanine-DNA-methyltransferase，MGMT)启动子甲基化方面与IDH突变型GBM间的差异均具有统计学意义(

0.05)。对于行常规治疗的IDH野生型GBM患者，单因素Cox危险度分析显示，肿瘤大部全切除、MGMT启动子甲基化、放疗启动时间≥5周且＜6周、替莫唑胺(temozolomide

TMZ)辅助化疗≥6个周期是影响患者总体生存时间(overall survival，OS)的保护性因素；肿瘤位于左侧大脑半球、累及单个脑叶、MGMT启动子甲基化、放疗启动时间≥5周且＜6周是影响患者无肿瘤进展生存时间(progression free survival，PFS)的保护性因素(

均

0.05)。进一步多因素Cox危险度回归分析显示，MGMT启动子甲基化、放疗启动时间≥5周且＜6周、术后TMZ辅助化疗≥6个周期是影响患者OS的独立保护性因素；肿瘤位于左侧大脑半球、累及单个脑叶、MGMT启动子甲基化则是影响患者PFS的独立保护性因素(

均

0.05)。

结论

IDH突变型GBM与野生型GBM患者临床和预后特征迥异，后续须进一步完善相关分子检测明确其病理类型；MGMT启动子甲基化是IDH野生型GBM患者相对良好预后重要指标；术后略微延迟启动放疗(术后≥5周及＜6周)可显著改善IDH野生型GBM患者生存预后。

Abstract

Objective

To explore the clinical features

treatment and prognosis of glioblastomas (GBM) in adults.

Methods

A retrospective cohort study was performed on 176 adult GBM patients admitted to our department from January 2015 to December 2021.

Chi

-square test was used to investigate the clinical differences between isocitrate dehydrogenase (IDH) mutant and wild-type GBM. Kaplan-Meier and Log-Rank tests were employed to plot survival curve and compute the survival analysis. Multivariate Cox regression model was applied to identify the independent prognostic factors.

Results

IDH wild-type GBM account for 89.2% and had significantly differences from the IDH-mutant GBM in terms of age of onset

Karnofsky (KPS) score at admission

symptoms of neurological deficit

and methylation status of O

-methylguanine-DNA-methyltransferase (MGMT) promoter (

0.05). For the IDH wild-type GBM patients receiving conventional therapy

univariate Cox hazard analysis showed gross total resection

methylation of MGMT promoter

initiation of radiation within the 5th to 6th week

after surgery

and adjuvant temozolomide (TMZ) chemotherapy ≥6 cycles were favorable prognostic factors for overall survival (OS); GBMs in the left hemisphere

involvement of single lobe

methylation of MGMT promoter

and initiation of radiation within the 5th to 6th week after surgery were favorable prognostic factors for progression free survival (PFS) (all

0.05). Moreover

multivariate Cox hazard regression analysis indicated that methylation of MGMT promoter

and initiation of radiation within the 5th to 6th week after surgery

and adjuvant TMZ chemotherapy ≥6 cycles were independent protective factors for OS

and GBMs in the left hemisphere

involvement of single lobe and methylation of MGMT promoter were independent protective factors for PFS in the GBM patients (all

0.05).

Conclusion

The clinical and prognostic features are totally different between IDH mutant and wild-type GBM

and molecular detections are needed for the further pathological classification. Methylation of MGMT promoter is a primary marker of favorite prognosis for IDH wild-type GBM

and slightly delay in radiotherapy (the 5th to 6th week after surgery) can effectively improve the survival prognosis of IDH wild-type GBM.

关键词

Keywords

references

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