脑胶质瘤患者术后早期复发危险因素分析及预测模型构建

摘要/Abstract

摘要：

目的探讨胶质瘤患者术后早期复发的相关影响因素,并构建早期复发预测模型。方法回顾性分析2014年8月至2016年7月徐州医科大学附属医院收治的94例经病理诊断为胶质瘤的患者。运用Kaplan-Meier法进行生存分析,并行log-rank检验,Cox比例风险回归模型分析影响胶质瘤患者术后早期复发的临床因素,并建立早期复发预测模型。结果术后12个月内和24个月内的复发率分别为26.6%(25/94)和39.4%(37/94)。单因素分析显示,年龄(χ²=9.59,P=0.008)、肿瘤切除程度(χ²=14.26,P<0.001)、Karnofsky功能状态(KPS)评分(χ²=19.41,P<0.001)、是否放化疗(χ²=5.10,P=0.024)、病理分级(χ²=5.83,P=0.016)与胶质瘤患者术后早期复发有关。多因素Cox比例风险回归模型分析显示,病理分级(OR=2.64,95%CI为1.75~3.97,P<0.001)、切除程度(OR=0.34,95%CI为0.19~0.62,P<0.001)和放化疗(OR=2.58,95%CI为1.34~4.99,P=0.005)是胶质瘤患者术后早期复发的独立影响因素。胶质瘤患者术后早期复发风险函数模型表达式为h(t)=h₀exp(0.970X₁-1.081X₂+0.949X₃)。X₁、X₂、X₃分别表示病理分级、切除程度和放化疗。结论病理高级别、未进行放化疗是影响胶质瘤患者早期复发的独立危险因素,肿瘤完全切除可以降低术后早期复发的风险,改善预后。构建的早期复发预测模型可以为临床诊疗工作提供一定的参考依据。

关键词:胶质瘤,早期复发,危险因素,预测模型

Abstract:

ObjectiveTo investigate the related factors of early postoperative recurrence of glioma patients and to establish a prediction model for early recurrence.MethodsA total of 94 patients with pathologically diagnosed glioma treated at Affiliated Hospital of Xuzhou Medical University from August 2014 to July 2016 were retrospectively analyzed. Kaplan-Meier method was used for survival analysis and log-rank test was carried out. Cox proportional risk regression model was used to analyze the clinical factors influencing early postoperative recurrence of glioma patients, and the prediction model of early recurrence was established.ResultsThe recurrence rates were 26.6% (25/94) and 39.4% (37/94) at 12 months and 24 months after operation, respectively. Univariate analysis showed that age (χ²=9.59,P=0.008), degree of tumor resection (χ²=14.26,P<0.001), Karnofsky performance status (KPS) score (χ²=19.41,P<0.001), radiochemotherapy (χ²=5.10,P=0.024) and pathological grade (χ²=5.83,P=0.016) were significantly associated with early postoperative recurrence in glioma patients. Multivariate Cox proportional hazards regression model analysis showed that pathological grade (OR=2.64, 95%CI: 1.75-3.97,P<0.001), degree of resection (OR=0.34, 95%CI: 0.19-0.62,P<0.001) and radiochemotherapy (OR=2.58, 95%CI: 1.34-4.99,P=0.005) were independent factors influencing early postoperative recurrence in glioma patients. The risk function model expression of early recurrence in glioma patients was h(t)=h₀exp(0.970X₁-1.081X₂+0.949X₃). X₁, X₂and X₃represented pathological grade, resection degree and radiochemotherapy respectively.ConclusionHigh grade pathology and the absence of radiochemotherapy are independent predictors of early recurrence in glioma patients, and complete tumor resection can reduce the risk of early recurrence and improve the prognosis. The model of early recurrence prediction can provide some reference for clinical diagnosis and treatment.

Key words:Glioma,Early recurrence,Risk factors,Prediction model

朱一硕, 崔玉洁, 刘崎, 李军, 范月超. 脑胶质瘤患者术后早期复发危险因素分析及预测模型构建[J]. 国际肿瘤学杂志, 2022, 49(2): 79-83.

Zhu Yishuo, Cui Yujie, Liu Qi, Li Jun, Fan Yuechao. Analysis of risk factors and prediction model establishment for early postoperative recurrence in glioma patients[J]. Journal of International Oncology, 2022, 49(2): 79-83.

图/表2

表1

94例胶质瘤患者术后早期复发的单因素分析"

临床病理特征	例数	中位无复发生存时间(月)	χ²值	P值
性别
男	56	12.0	0.71	0.398
女	38	15.5
年龄(岁)
<30	19	25.0
30~50	46	14.5	9.59	0.008
>50	29	11.0
肿瘤部位
额叶	31	15.0
颞叶	16	13.0	3.31	0.347
顶叶	7	15.0
其他	40	11.0
肿瘤大小(cm)
<4	52	15.0	0.17	0.685
≥4	42	12.0
切除程度
部分切除	33	12.0	14.26	<0.001
完全切除	61	14.0
KPS评分
<70分	34	9.0	19.41	<0.001
≥70分	60	18.0
放化疗
否	41	12.0	5.10	0.024
是	53	15.0
病理分级
Ⅰ~Ⅱ	45	19.0	5.83	0.016
Ⅲ~Ⅳ	49	8.0

表1

危险因素	β值	SE值	Wald值	P值	OR值	95%CI
病理分级	0.97	0.21	21.62	<0.001	2.64	1.75~3.97
切除程度	-1.08	0.30	12.63	<0.001	0.34	0.19~0.62
放化疗	0.95	0.34	7.98	0.005	2.58	1.34~4.99

表2

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