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目的:探讨影响脑胶质瘤术后预后的相关因素,为临床治疗方案的选择及预后评估提供参考。方法:对86例经病理诊断证实的脑胶质瘤患者进行3年随访,回顾患者病历、影像学及病理资料,以病理分级、年龄等10项因素为解释变量,以生存状况为结局变量,先进行单因素Cox比例风险分析,对单因素分析P<0.10的变量再进行多因素Cox比例风险分析,筛选影响预后的独立因素,Kaplan-Meier法绘制暴露于不同独立因素下的生存折线,Log-rank检验。结果:(1)单因素分析显示:年龄≥50岁、高病理分级、低KPS评分、中线结构移位、次全切手术、放疗剂量<50 Gy者预后相对较差(P<0.05);(2)多因素分析显示:年龄、病理分级、KPS评分、放疗剂量纳入的回归方程有统计学意义(P<0.05或P<0.01);(3)放疗剂量≥50 Gy者较<50 Gy者预后好(χ2=8.120,P<0.01);病理分级越高生存周期越短(χ2=11.543,P<0.01);年龄<50岁者较≥50岁者生存状况好(χ2=4.662,P<0.05);KPS评分≥70分者较<70分者生存状况好(χ2=8.664,P<0.05)。结论:临床治疗方案的制订和预后评估应充分考虑患者年龄、KPS评分和病理分级,在一定范围内高剂量照射更有利于改善预后。
Objective: To investigate the related factors that influence the postoperative prognosis of gliomas and provide reference for the choice of clinical treatment options and prognosis. Methods: Eighty-six patients with glioma confirmed by pathology were followed up for 3 years. The medical records, imaging and pathological data were reviewed. Ten variables including pathological grade and age were used as explanatory variables. Survival status was taken as the outcome variable, Univariate Cox proportional hazards analysis was performed first, multivariate Cox proportional hazards analysis was performed on univariate analysis of P <0.10 variables, independent factors influencing prognosis were screened, Kaplan-Meier method was used to plot survival curves exposed to different independent factors, Log -rank test. Results: (1) Univariate analysis showed that the prognosis was worse (P <0.05) in patients with age≥50 years, high pathological grade, low KPS score, midline structure shift, subtotal resection and radiotherapy dose less than 50 Gy; (2) Multivariate analysis showed that the regression equation included age, pathological grade, KPS score and radiotherapy dose were statistically significant (P <0.05 or P <0.01); (3) The prognosis (Χ2 = 8.120, P <0.01). The higher the pathological grade was, the shorter the survival period was (χ2 = 11.543, P <0.01) ); KPS score ≥70 points were better than <70 points (χ2 = 8.664, P <0.05). Conclusion: The development of clinical treatment plan and prognosis evaluation should take full account of patient’s age, KPS score and pathological grade. Within a certain range, high-dose irradiation is more beneficial to improve prognosis.