Prognosis factors of survival time in patients with glioblastoma multiforme: a multivariate analysis of 340 patients
Prognosis factors of survival time in patients with glioblastoma multiforme: a multivariate analysis of 340 patients
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DOI：
10.1007/s00701-006-1092-y
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发表时间：
2007-03-01
影响因子：
2.4
通讯作者：
Dam-Hieu, P.
中科院分区：
文献类型：
--
作者：
Mineo, J. -F.;Bordron, A.;Dam-Hieu, P.
背景资料。尽管最近的治疗取得了进展，但多形性胶质母细胞瘤的预后仍然很差。一些临床和治疗因素以及肿瘤特征已被报道为对生存有重要意义。需要更有效地确定预后因素，以优化个体化治疗管理。本研究的目的是通过单因素和多因素分析来评估影响预后尤其是生存率的因素。对340例初诊GBM患者的临床资料进行回顾性分析。对影响生存时间的预后因素进行单因素分析。通过Kaplan-Meier生存曲线对看似决定性的因素进行评估。最后，在单变量分析中发现的显著因素在多变量分析中使用COX回归方法进行检验。多因素分析发现，影响生存率的主要因素是放射治疗，其次是根治性手术、肿瘤部位、年龄和化疗。接受替莫唑胺治疗的患者的存活率明显高于接受其他化疗的患者(对数等级检验，P<；0.005)。单因素分析提示基底膜类型(初诊或继发)、重复手术和部分手术(与单纯活检相比)的值，但未经COX回归方法证实。根治性手术后无进展生存期与总生存期呈正相关(r=0.87，P<；10E-5)。放射治疗对生存的影响大于年龄的影响，这一论点支持了患者至少在70岁之前接受放射治疗的主张。在复发的情况下，总体生存率和无进展生存率之间的相关性是考虑治疗方案时的一个重要因素。最初的根治性手术和重复的手术极大地影响了存活率。部分手术的益处仍然很难评估。部分手术可用于降低颅内压和减少残留肿瘤，以便能够通过化疗和放射治疗。替莫唑胺的治疗价值得到了肯定。
Background. The prognosis of glioblastoma multiforme remains poor despite recent therapeutic advances. Several clinical and therapeutic factors as well as tumour characteristics have been reported as significant to survival. A more efficient determination of the prognostic factors is required to optimize individual therapeutic management. The aim of our study was to evaluate by univariate then multivariate analysis the factors that influence prognosis and particularly survival.Methods. Data of 340 patients with newly-diagnosed GBM were retrospectively analyzed. Univariate analysis of prognosis factors of survival time was performed. Factors that seemed determinant were evaluated by Kaplan-Meier survival curves. Finally, the significant factors found in univariate analysis were tested in multivariate analysis using the COX regression method.Findings. Using multivariate analysis, the following factors were found to influence survival: radiotherapy was the predominant factor followed by radical surgery, tumour location, age and chemotherapy. Patients treated with temozolomide had a markedly better survival rate than patients treated with other chemotherapies (Log-rank test P < 0.005). The values of GBM type (de novo or secondary), as well as repeated surgery and partial surgery (vs. simple biopsy) were suggested by univariate analysis but not confirmed by the COX regression method. After radical surgery, progression-free survival was correlated to overall survival (r = 0.87, P < 10e-5).Conclusions. The influence of radiotherapy on survival was greater than the influence of age, an argument supporting the proposition of radiotherapy for patients until at least age 70. In the case of recurrence, the correlation between overall survival and progression-free survival is an important factor when considering the therapeutic options. Initial radical surgery and repeated procedures dramatically influence survival. The benefit of partial surgery remains difficult to evaluate. Partial surgery could be used to decrease intracranial pressure and to minimize residual tumours in order to enable treatment by chemotherapy and radiotherapy. The value of temozolomide treatment was confirmed.