【摘要】：研究背景與目的：神經(jīng)膠質(zhì)瘤源于神經(jīng)外胚層的腫瘤，是顱內(nèi)常見惡性腫瘤，雖然膠質(zhì)瘤發(fā)病率僅在全身腫瘤的2%，但因其生物學行為多呈浸潤性生長，由于手術(shù)難以徹底切除造成復發(fā)率高，術(shù)后腫瘤細胞耐藥性強，且放療后可能加重癥狀，都嚴重影響患者的術(shù)后生存時間與質(zhì)量，導致患者出現(xiàn)嚴重的殘疾乃至死亡，本研究亦在探討影響膠質(zhì)瘤病人術(shù)后生存規(guī)律、時間的相關(guān)因素，了解各因素間有無相應(yīng)關(guān)系，為臨床治療膠質(zhì)瘤及判斷膠質(zhì)瘤患者預后提供參考。 研究方法：選取2008年1月~2010-12月安徽醫(yī)科大學第一附屬醫(yī)院神經(jīng)外科資料齊全的119例神經(jīng)膠質(zhì)瘤患者臨床資料，搜集患者病例資料。其中包括：性別，男性66例，女性53例；年齡大于50歲70例，小于50歲49例；術(shù)前KPS評分大于等于70分63例，小于70分56例；術(shù)前存在癲癇患者14例，無癲癇患者104例；術(shù)前腫瘤直徑大于等于5cm的患者有89例，小于5cm的有30例；手術(shù)全切者90例，次全切除29例；將術(shù)后病理級別根據(jù)WHO分級劃分為高級別組（WHO III~IV級，High GradeGlioma）和低級別組（WHO I~II級，Low Grade Glioma, LGG）,HGG83例，LGG36例；腫瘤細胞Ki-67指數(shù)＜10%有49例，，Ki-67≥10%有42例；術(shù)后進行放療92例，進行化療91例。隨訪已死亡者獲完全數(shù)據(jù)，術(shù)后死亡,術(shù)后死于非原發(fā)病者和失去隨訪者獲取截尾數(shù)據(jù)。以性別、年齡、術(shù)前KPS評分、腫瘤病理分級等10項因素為解釋變量，應(yīng)用COX回歸模型進行相關(guān)因素的測定，以P0.05為統(tǒng)計學判斷標準，計算不同分組患者中位生存月，并對于各項參數(shù)應(yīng)用Kaplan-Meier法繪制生存曲線。結(jié)果：應(yīng)用單因素分析表明，患者發(fā)病年齡＜50歲患者（n=70）中位生存時間24個月，較年齡≥50歲（n=49）中位生存期10個月明顯延長(P=0.004)；術(shù)前KPS評分≥70患者（n=63）中位生存月為26個月，高于術(shù)前KPS評分＜70患者（n=56，中位生存月13個月），P=0.001。HGG中位生存期（15個月）較LGG（43個月）明顯縮短P=0.001。腫瘤組織Ki-67指數(shù)＜10%中位生存期35個月，Ki-67指數(shù)≥10%為13個月，P=0.001。術(shù)后進行放療患者較不進行放療患者中位生存期延長9個月（分別為21個月和12個月,P=0.009）；而COX多因素分析表明，術(shù)前KPS評分(P0.01)、腫瘤病理分級(P0.01)、腫瘤組織Ki-67指數(shù)(P0.01)及術(shù)后是否放療P0.01)4個因素對于膠質(zhì)瘤患者預后生存有相關(guān)性影響。 結(jié)論：年齡≥50歲，高級別膠質(zhì)瘤、KPS評分70及Ki-67高表達的患者預后較差，術(shù)后有效的放化療顯著改善生存期；患者的性別、腫瘤直徑大小、手術(shù)切除程度、術(shù)前有無癲癇對于膠質(zhì)瘤患者的預后影響不明顯。臨床治療中觀察以上指標對于膠質(zhì)瘤的治療預后的判斷具有更強的指導意義
[Abstract]:Background & objective: gliomas originate from neuroectodermal tumors and are common intracranial malignant tumors. Because the recurrence rate is high, the tumor cell resistance is strong, and the symptoms may be aggravated after radiotherapy, the survival time and quality of the patients are seriously affected, resulting in serious disability and even death of the patients. This study was also to explore the relevant factors affecting the survival rule and time of glioma patients, and to find out whether there was a corresponding relationship between these factors, and to provide a reference for clinical treatment of gliomas and prognosis of glioma patients. Methods: 119 patients with glioma were collected from the first affiliated Hospital of Anhui Medical University from January to December, 2008. Including: sex, 66 males, 53 females, 70 cases aged over 50 years, 49 cases younger than 50 years, 63 cases with preoperative KPS score greater than 70 points, 56 cases with less than 70 points, 14 cases with epilepsy before operation, 104 cases without epilepsy. There were 89 cases with tumor diameter greater than or equal to 5cm before operation, 30 cases with less than 5cm, 90 cases with total resection and 29 cases with subtotal resection. According to the WHO grade, the postoperative pathological grades were divided into WHO III~IV high GradeGlioma group and WHO I~II low Grade Glioma, LGG) HGG83 cases, tumor cell Ki-67 index < 10% in 49 cases and Ki-67 鈮

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