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Title: [Factor analysis of cerebrospinal fluid spread in glioblastoma].
Author: Huang J, Li MX, Ma ML, Ren XH, Cui Y, Lin S.
Journal: Zhonghua Wai Ke Za Zhi; 2020 Jun 01; 58(6):469-474. PubMed ID: 32498488.
Abstract:
Objective: To analyze the prognosis factors of cerebrospinal fluid (CSF) spread after surgery in glioblastoma (GBM) patients when tumors progressed and the effect factors on prognosis. Methods: A retrospective study was conducted on 124 patients who were pathologically diagnosed as glioblastoma after surgery, and found tumor progressed during regularly follow-up at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University between January 2009 and August 2017.There were 82 males and 42 females, aged 47.9 years(range: 19 to 75 years) .Patients were divided into local recurrence group(96 cases) and CSF spread group (28 cases) .Clinical data were recorded in detail and compared by independent sample t test or χ(2) test.Kaplan-Meier survival curves was used to demonstrated the distribution of progression free survival (PFS) overall survival (OS) and post progression survival (PPS), and differences between local recurrence and CSF spread groups were assessed by Log-rank test.Cox proportion hazard regression analysis was used to identify independent prognostic factors. Results: Logistics regression analysis showed ventricle entry was the only prognosis factor of CSF spread (OR=2.667, 95% CI: 1.128 to 6.304, P=0.025).No significant distinction was observed in PFS between CSF spread group and local recurrence group(7.0 months vs.9.3 months, P=0.066).However, OS and PPS were substantially shortened in CSF spread group (13.0 months vs.23.0 months, P=0.011; 6.0 months vs.11.0 months, P=0.022, respectively).Mutations of isocitrate dehydrogenase gene, distant spread, gross-total resection, Ki-67 index>30% were independent prognostic factors of GBM patients. Conclusions: Ventricle entry is a prognosis factor for CSF spread, after which the median OS and PPS are markedly diminished.However, ventricle entry is not independent prognosis factor shortening survival. 目的： 探讨脑胶质母细胞瘤（GBM）切除术后患者发生脑脊液播散的危险因素及预后因素。 方法： 回顾性分析首都医科大学附属北京天坛医院神经外科2009年1月至2017年8月施行手术治疗且术后随访期间肿瘤复发的124例原发性GBM患者的临床资料。男性82例，女性42例，年龄47.9岁（范围：19~75岁），按复发情况分为原位复发组（96例），颅内播散组（28例）。采用独立样本t检验、χ(2)检验对两组患者的临床资料进行单因素分析，采用Logistic回归进行多因素分析确定患者脑脊液播散的危险因素。采用Kaplan-Meier法绘制生存曲线，Log-rank法比较生存曲线间的差异，并用Cox单因素及多因素生存分析筛选影响患者的预后因素。 结果： 单因素及多因素分析结果显示，脑室开放是发生颅内播散的预后因素（OR=2.667，95%CI：1.128~6.304，P=0.025）。颅内播散组与原位复发组相比，中位无进展生存时间差异无统计学意义（7.0个月比9.3个月，P=0.066），而中位总生存时间、中位复发后生存时间明显缩短（13.0个月比23.0个月，P=0.011；6.0个月比11.0个月，P=0.022）。多因素生存分析结果显示，肿瘤异柠檬酸脱氢酶基因突变、远隔播散、肿瘤全切除、Ki-67指数>30%是患者的独立预后因素（P均<0.05）。 结论： 脑室开放是造成GBM发生脑脊液播散的危险因素，脑脊液播散患者的生存时间明显缩短；但脑室开放不是患者的独立预后因素。.

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