Risk factors of postoperative recurrence in patients with primary brain glioma and prediction model construction

Abstract

Abstract:

ObjectiveTo investigate the risk factors of postoperative recurrence in patients with primary brain glioma and to construct a prediction model.MethodsA total of 98 patients with primary brain glioma treated by radical surgery in Nanchong Central Hospital from January 2018 to January 2021 were retrospectively included， and were divided into recurrent group （40 cases） and non-recurrent group （58 cases） according to whether there was recurrence or not during the follow-up period. The independent influencing factors for postoperative recurrence in patients with primary brain glioma were evaluated by multivariate logistic regression. Logistic prediction model of postoperative recurrence risk of patients with primary brain glioma was established， and the predictive efficacy of each index was calculated by receiver operator characteristic （ROC） curve.ResultsThere were statistically significant differences between recurrent group and non-recurrent group in glioma World Health Organization （WHO） grade（χ²=12.48，P<0.001）， isocitrate dehydrogenase （IDH）1/2 mutation （χ²=13.24，P<0.001）， mean platelet volume （MPV）（t=5.34，P<0.001）， and MPV/platelet count （PLT）（t=9.73，P<0.001）. Multivariate analysis showed that WHO grade Ⅲ-Ⅳ （OR=8.54， 95%CI：1.62-44.99，P=0.011）， IDH1/2 wild type （OR=9.08， 95%CI：1.68-49.19，P=0.010）， low MPV （OR=0.46， 95%CI：0.21-0.99，P=0.048） and low MPV/PLT （OR=0.02， 95%CI：0.01-0.03，P<0.001） were independent risk factors for postoperative recurrence in patients with primary brain glioma. The logistic prediction model based on the above indicators was logit（P）=11.78+2.15×WHO grade+2.21×IDH1/2 mutation situation-0.78×MPV-200.70×MPV/PLT （R²=0.785）.The ROC curve analysis results showed that WHO grade， IDH1/2 mutation， MPV， MPV/PLT， and logistic prediction modelP-value could all be used to predict the risk of postoperative recurrence in patients with primary brain glioma； The areas under the curve were 0.681， 0.684， 0.783， 0.920 and 0.964， respectively. In the area under ROC curve comparison of each indicator， the predictive performance of the logistic regression modelP-value was significantly higher than that of other indicators （allP<0.05）.ConclusionPostoperative recurrence in patients with primary brain glioma may be related to glioma WHO grade， IDH1/2 mutation and platelet related laboratory indexes. The model constructed based on the above indicators can be used to predict the recurrence risk in patients with primary brain glioma after surgery.

Key words:Glioma,Recurrence,Prognosis,Blood platelets

Liu Pingping, He Xuefang, Zhang Yi, Yang Xu, Zhang Shanshan, Ji Yifei. Risk factors of postoperative recurrence in patients with primary brain glioma and prediction model construction[J]. Journal of International Oncology, 2024, 51(4): 193-197.

Figures/Tables4

临床特征	未复发组（n=58）	复发组（n=40）	t/χ²值	P值
年龄（岁）	37.09±7.27	35.34±5.90	1.26	0.210
性别
男	40（68.97）	27（67.50）	0.02	0.878
女	18（31.03）	13（32.50）	0.02	0.878
体质量指数（kg/m²）	23.10±2.63	23.37±2.95	-0.48	0.636
肿瘤最大径（cm）
≤4	23（39.66）	17（42.50）	0.08	0.778
>4	35（60.34）	23（57.50）	0.08	0.778
肿瘤位置
颞叶	19（32.76）	13（32.50）	0.55	0.908
额叶	16（27.59）	11（27.50）
顶叶	18（31.03）	14（35.00）
其他	5（8.62）	2（5.00）
WHO分级
Ⅰ~Ⅱ级	37（63.79）	11（27.50）	12.48	<0.001
Ⅲ~Ⅳ级	21（36.21）	29（72.50）	12.48	<0.001
术前KPS评分（分）
≤80	40（68.97）	27（67.50）	0.02	0.878
>80	18（31.03）	13（32.50）	0.02	0.878
术后辅助化疗	24（41.38）	17（42.50）	0.01	0.912
术后辅助放疗	37（63.79）	25（62.50）	0.02	0.896
IDH1/2突变情况
野生型	25（43.10）	32（80.00）	13.24	<0.001
突变型	33（56.90）	8（20.00）	13.24	<0.001
实验室指标
PLT（×10⁹/L）	188.21±43.08	194.40±45.16	-0.69	0.495
PDW（fl）	11.89±2.58	12.10±2.67	-0.39	0.697
PCT（%）	0.18±0.04	0.19±0.06	-0.99	0.324
MPV（fl）	8.91±1.03	7.84±0.87	5.34	<0.001
MPV/PLT	0.05±0.01	0.03±0.01	9.73	<0.001

变量	β值	SE值	Waldχ²值	OR值	95%CI	P值
WHO分级（Ⅰ~Ⅱ级为对照）	2.15	0.85	6.41	8.54	1.62~44.99	0.011
IDH1/2突变情况（突变型为对照）	2.21	0.86	6.55	9.08	1.68~49.19	0.010
MPV	-0.78	0.40	3.91	0.46	0.21~0.99	0.048
MPV/PLT	-200.70	46.67	18.50	0.02	0.01~0.03	<0.001
常量	11.78	3.93	8.98	0.00		0.003

项目	曲线下面积	敏感性（%）	特异性（%）	约登指数（%）
WHO分级	0.681^a	72.50	63.79	36.29
IDH1/2突变情况	0.684^b	80.00	56.90	36.90
MPV	0.783^c	82.50	72.41	54.91
MPV/PLT	0.920^d	90.00	82.76	72.76
logistic预测模型P值	0.964	95.00	93.10	88.10

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