脑胶质瘤患者术后的生存质量和生存分析
摘要
脑胶质瘤是最常见的颅内肿瘤之一。我国颅内肿瘤总的发病率为32/10万人,其中脑胶质瘤占颅内肿瘤的35.26～60.96%(平均44.69%)。脑胶质瘤可发生在任何年龄,但以20岁至50岁为最多。恶性程度低的脑胶质瘤平均存活时间为3～5年,恶性程度高的脑胶质瘤平均存活时间1～2年。颅内肿瘤严重危害人类健康。手术治疗和术后放、化疗给患者及其家庭带来极大的痛苦和沉重的经济负担;肿瘤所导致的劳动力过早丧失,以及手术可能导致的永久性残疾将严重影响个人和家庭的生活质量,带来一定的社会问题。因此,除提高脑胶质瘤的诊断、治疗水平外,更应从预防和控制肿瘤的发生入手,降低肿瘤的发病率。目前,尽管有许多先进的诊疗技术的临床应用并已取得了一定的效果,但综观其长期疗效尚未取得令人满意的结果。目前胶质瘤的治疗仍是采取以手术为主的综合治疗。
生存质量作为可以全面反映患者健康状况的指标,可望更客观地对治疗效果进行评估。本研究主要分析了脑胶质瘤患者术后生存质量及生存期的影响因素,并用生存质量的相关指标来评价手术疗效和患者术后的生存情况,以期为临床肿瘤患者术后的生存质量及生存提供理论依据。该研究不仅具有重要的现实意义和一定的学术价值,而且具有较大的经济和社会效益。
本研究选择自2000年至2006年间在山东大学齐鲁医院行手术治疗的522例脑胶质瘤患者作为研究对象,通过对病历资料分析和病例随访获取资料,随访时间从12个月至72个月。利用图解法和数值法探讨患者术后生存质量与生存时间的分布规律,在统计描述的基础上,选择年龄、性别、职业、学历、肿瘤部位、术前Kfs评分、病理级别、术前癫痫发作、手术切除程度、术中出血、输血、手术时间、是否有并发症、术后癫痫发作、术后放疗、术后化疗、费用支付方式等多项可能影响预后的因素进行生存质量及生存分析。生存分析单因素方法分别采用t检验、χ~2检验、Wilcoxon秩和检验、Kruskal-Wallis秩和检验和Log-rank对数秩检验,多因素方法采用多元Logistic回归模型以及Cox比例风险回归模型。
主要研究结果如下:
1、对生存质量的影响因素分析
(1)经单因素分析结果显示:(α=0.05)
影响1月kfs的因素有:年龄、病理诊断、切除程度、出血量、术中输血、
影响3月kfs的因素有:年龄、病理诊断、出血量、术中输血
影响1年kfs的因素有:年龄、病理诊断、切除程度、出血量
影响3年kfs的因素有:年龄、病理诊断
影响5年kfs的因素有:年龄、性别、病理诊断、切除程度
(2)经多因素分析结果显示:(α=0.05)
影响1月kfs的因素有:年龄、病理诊断、术中出血量
影响3月kfs的因素有:年龄、病理诊断、术中输血量
影响1年kfs的因素有:年龄、病理诊断、术中出血量
影响3年kfs的因素有:年龄、病理诊断、术中出血量
影响5年kfs的因素有:年龄、病理诊断、手术切除程度术中出血量和输血量两个变量间有正相关关系,等级相关系数=0.4772,P＜0.0001。
2、对患者术后生存的影响因素分析
(1)单因素分析结果显示:
年龄、性别、手术切除程度、病理级别等因素与患者预后有关(p＜0.01)。
(2)多因素分析结果显示:
患者的年龄、手术切除程度、病理分级、术后放疗因素均为影响预后的独立因素。
结论:
1、影响脑胶质瘤患者术后生存质量的主要因素是年龄、病理诊断、术中出血量。
2、年龄、手术切除程度、病理级别、术后放疗、术后化疗、费用支付方式等因素是影响脑胶质瘤患者术后生存的主要因素;患者的学历、职业、肿瘤部位、术前Kfs评分、术前癫痫发作、手术时间、术后是否有并发症、手术前后有无癫痫发作与其生存期无明显的相关性。
Glioma is the most familiar disease of encephalic tumors. The incidence rate of encephalic tumors is 32 /100000, of which glioma occupy 35.26% to 60.96% (the median is 44.69%). These diseases are more likely developed in the persons who are 20 to 50 years old. The prognosis of most malignant gliomas is worse. The mean survival time of low malignacy tumor patients are 3 to 5 years, and the high malignancy primary tumor patients are 1 to 2 years. The tumors seriously influence the health of humanity.During the surgery and radio or chemical therapy, patients would feel great distress and their families have to afford huge economic expends. Possible permanent disability and deprivation of labor due to the tumors or surgery therapy would seriously reduce the life quality of patients and their families, and it may lead to some social problems. So it is very important to take preventive measures to reduce the incidence of glioma exclude dedicating to the improvement of diagnosis and therapy of the tumors. At present, many advanced techniques of diagnosis and treatment have been applied to clinic and have gotten sound effects, but its long-term effects are still not satisfactory. The synthetic cure giving prioty to operation is yet the fundamental principle followed in cure of glioma.
Qualit of life (QOF) as a scale reflecting the patients' healthy situation can be counted on to appraise the effects of cure objectively and fully. The research applies statistiacl analysis to identify prognostic fators for survival and appraise the curative effects of operation in patients with giloma after surgery. This is a problem to be settled urgently. Hence the research has important significance in theory and parctical vuale in use.
The research subjects consisted of 522 patients who were operated at QiluHospital of Shandong University between 2000 and 2006. The data were gotten by case recorder and follow-up which is between 12 to 72 months. On the basis of satsitical description, we select 17 related factors for analyzing which include age, sex, occupation, educational background, tumour location, Kfs score before surgery, pathological grades, epilepsy seizure before surgery, extent of resection in surgery, bleeding in surgery, blood transfusion, operation time, complications, epilepsy seizure after surgery, chemotherapy after surgery, radiotherapy after surgery, cost pay method. For the univariate analysis, we use t test, x~2 test, Wilcoxon test, Kruskal-Wallis test. Kaplan-Meier's Product-Limit Survival Estimates method and Log-rank test. Multivariate regression analysis uses Logistic proportional-hazards model and COX proportional-hazards model.
The main results of the study are as follwos.
1. The factors affecting the quality of life.
(1) Univariate analysis(α=0.05):
1 month: age, pathological grades, extent of resection in surgery, bleeding in surgery,blood transfusion
3 months: age, pathological grades, bleeding in surgery, blood transfusion
1 year: age, pathological grades, extent of resection in surgery, bleeding in surgery
3 years: age, pathological grades
5 years: age, sex, pathological grades, extent of resection in surgery
(2) Multivariate analysis(a=0.05):
1 month: age, pathological grades, bleeding in surgery
3 months: age, pathological grades, bleeding in surgery
1 year: age, pathological grades, bleeding in surgery
3 years: age, pathological grades, bleeding in surgery
5 years: age, pathological grades, extent of resection in surgery
2. The factors affecting the survival of postoperation:
(1) In Univariate analysis, the statistic significance was observed in patient age, sex, extent of resection in surgery, pathological grades.
(2) While Multivariate survival analysis showed that patient age, extent of resection insurgery, pathological grades, chemotherapy after surgery were independentstatistically significant prognostic factors.
Conclusion:
1. The main factors that affecting the quality of life in patients with glioma is age, pathological grades and bleeding in surgery.
2. Age, extent of resection in surgery, pathological grades, chemotherapy after surgery, radiotherapy after surgery and cost pay method are the main factors that affecting the survival of postoperation in patients with glioma; while sex, educational background, occupation, bleeding in surgery, blood transfusion, tumour location, KFS score before surgery, pathological grades, epilepsy seizure before surgery, operation time, complications and epilepsy seizure after surgery have no significant correlation with survival.
生存质量作为可以全面反映患者健康状况的指标,可望更客观地对治疗效果进行评估。本研究主要分析了脑胶质瘤患者术后生存质量及生存期的影响因素,并用生存质量的相关指标来评价手术疗效和患者术后的生存情况,以期为临床肿瘤患者术后的生存质量及生存提供理论依据。该研究不仅具有重要的现实意义和一定的学术价值,而且具有较大的经济和社会效益。
本研究选择自2000年至2006年间在山东大学齐鲁医院行手术治疗的522例脑胶质瘤患者作为研究对象,通过对病历资料分析和病例随访获取资料,随访时间从12个月至72个月。利用图解法和数值法探讨患者术后生存质量与生存时间的分布规律,在统计描述的基础上,选择年龄、性别、职业、学历、肿瘤部位、术前Kfs评分、病理级别、术前癫痫发作、手术切除程度、术中出血、输血、手术时间、是否有并发症、术后癫痫发作、术后放疗、术后化疗、费用支付方式等多项可能影响预后的因素进行生存质量及生存分析。生存分析单因素方法分别采用t检验、χ~2检验、Wilcoxon秩和检验、Kruskal-Wallis秩和检验和Log-rank对数秩检验,多因素方法采用多元Logistic回归模型以及Cox比例风险回归模型。
主要研究结果如下:
1、对生存质量的影响因素分析
(1)经单因素分析结果显示:(α=0.05)
影响1月kfs的因素有:年龄、病理诊断、切除程度、出血量、术中输血、
影响3月kfs的因素有:年龄、病理诊断、出血量、术中输血
影响1年kfs的因素有:年龄、病理诊断、切除程度、出血量
影响3年kfs的因素有:年龄、病理诊断
影响5年kfs的因素有:年龄、性别、病理诊断、切除程度
(2)经多因素分析结果显示:(α=0.05)
影响1月kfs的因素有:年龄、病理诊断、术中出血量
影响3月kfs的因素有:年龄、病理诊断、术中输血量
影响1年kfs的因素有:年龄、病理诊断、术中出血量
影响3年kfs的因素有:年龄、病理诊断、术中出血量
影响5年kfs的因素有:年龄、病理诊断、手术切除程度术中出血量和输血量两个变量间有正相关关系,等级相关系数=0.4772,P＜0.0001。
2、对患者术后生存的影响因素分析
(1)单因素分析结果显示:
年龄、性别、手术切除程度、病理级别等因素与患者预后有关(p＜0.01)。
(2)多因素分析结果显示:
患者的年龄、手术切除程度、病理分级、术后放疗因素均为影响预后的独立因素。
结论:
1、影响脑胶质瘤患者术后生存质量的主要因素是年龄、病理诊断、术中出血量。
2、年龄、手术切除程度、病理级别、术后放疗、术后化疗、费用支付方式等因素是影响脑胶质瘤患者术后生存的主要因素;患者的学历、职业、肿瘤部位、术前Kfs评分、术前癫痫发作、手术时间、术后是否有并发症、手术前后有无癫痫发作与其生存期无明显的相关性。
Glioma is the most familiar disease of encephalic tumors. The incidence rate of encephalic tumors is 32 /100000, of which glioma occupy 35.26% to 60.96% (the median is 44.69%). These diseases are more likely developed in the persons who are 20 to 50 years old. The prognosis of most malignant gliomas is worse. The mean survival time of low malignacy tumor patients are 3 to 5 years, and the high malignancy primary tumor patients are 1 to 2 years. The tumors seriously influence the health of humanity.During the surgery and radio or chemical therapy, patients would feel great distress and their families have to afford huge economic expends. Possible permanent disability and deprivation of labor due to the tumors or surgery therapy would seriously reduce the life quality of patients and their families, and it may lead to some social problems. So it is very important to take preventive measures to reduce the incidence of glioma exclude dedicating to the improvement of diagnosis and therapy of the tumors. At present, many advanced techniques of diagnosis and treatment have been applied to clinic and have gotten sound effects, but its long-term effects are still not satisfactory. The synthetic cure giving prioty to operation is yet the fundamental principle followed in cure of glioma.
Qualit of life (QOF) as a scale reflecting the patients' healthy situation can be counted on to appraise the effects of cure objectively and fully. The research applies statistiacl analysis to identify prognostic fators for survival and appraise the curative effects of operation in patients with giloma after surgery. This is a problem to be settled urgently. Hence the research has important significance in theory and parctical vuale in use.
The research subjects consisted of 522 patients who were operated at QiluHospital of Shandong University between 2000 and 2006. The data were gotten by case recorder and follow-up which is between 12 to 72 months. On the basis of satsitical description, we select 17 related factors for analyzing which include age, sex, occupation, educational background, tumour location, Kfs score before surgery, pathological grades, epilepsy seizure before surgery, extent of resection in surgery, bleeding in surgery, blood transfusion, operation time, complications, epilepsy seizure after surgery, chemotherapy after surgery, radiotherapy after surgery, cost pay method. For the univariate analysis, we use t test, x~2 test, Wilcoxon test, Kruskal-Wallis test. Kaplan-Meier's Product-Limit Survival Estimates method and Log-rank test. Multivariate regression analysis uses Logistic proportional-hazards model and COX proportional-hazards model.
The main results of the study are as follwos.
1. The factors affecting the quality of life.
(1) Univariate analysis(α=0.05):
1 month: age, pathological grades, extent of resection in surgery, bleeding in surgery,blood transfusion
3 months: age, pathological grades, bleeding in surgery, blood transfusion
1 year: age, pathological grades, extent of resection in surgery, bleeding in surgery
3 years: age, pathological grades
5 years: age, sex, pathological grades, extent of resection in surgery
(2) Multivariate analysis(a=0.05):
1 month: age, pathological grades, bleeding in surgery
3 months: age, pathological grades, bleeding in surgery
1 year: age, pathological grades, bleeding in surgery
3 years: age, pathological grades, bleeding in surgery
5 years: age, pathological grades, extent of resection in surgery
2. The factors affecting the survival of postoperation:
(1) In Univariate analysis, the statistic significance was observed in patient age, sex, extent of resection in surgery, pathological grades.
(2) While Multivariate survival analysis showed that patient age, extent of resection insurgery, pathological grades, chemotherapy after surgery were independentstatistically significant prognostic factors.
Conclusion:
1. The main factors that affecting the quality of life in patients with glioma is age, pathological grades and bleeding in surgery.
2. Age, extent of resection in surgery, pathological grades, chemotherapy after surgery, radiotherapy after surgery and cost pay method are the main factors that affecting the survival of postoperation in patients with glioma; while sex, educational background, occupation, bleeding in surgery, blood transfusion, tumour location, KFS score before surgery, pathological grades, epilepsy seizure before surgery, operation time, complications and epilepsy seizure after surgery have no significant correlation with survival.
引文
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[11]Nelson D F,Diener West M,Weinstein A S,et al.A Randomized comparison of misonidazole sensitized randiotherapy plus BCNU and radiotherapy plus BCNU for treatment of malignant glioma after sungery:final report of an RTOG study [J].International Journal of Radiation Oncology,1986,12(10):1793-1800
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[15]Klein M,Engelberts NH,Van Der Ploeg HM,et al.Epilepsy in low-grade gliomas:the impact on cognitive function and quality of life[J].Ann Neurol,2003,54(4):514.
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[17]Lunsford LD.Quantitative in aging study of extent of surgical resection and prognosis of malignant astrocytomas[J].Ann Intern Med,1988,107:402-424
[18]Imperato JP,Paleologos NA,Vick NAEffects of treatment on one-term surviors with malignant astrocytomas[J].Ann Neurol,1990,28:818
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