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脑恶性胶质瘤术后放化疗肿瘤复发再手术治疗的临床研究

Clinical research of reoperation in the treatment of patients with recurrent brain malignant gliomas after initial surgery and chemoradiotherapy

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【作者】 步星耀郭晓鹤丁玉超程培训闫兆月周伟马春晓张建国郭锁成邢亚洲

【Author】 BU Xing-yao,GUO Xiao-he,DING Yu-chao,CHENG Pei-xun,YAN Zhao-yue,ZHOU Wei,MA Chun-xiao,ZHANG Jian-guo,GUO Suo-cheng,XING Ya-zhou.Department of Neurosurgery,Henan Provincial People′s Hospital,Zhengzhou 450003,China

【机构】 河南省人民医院神经外科河南中医学院基础医学院

【摘要】 目的探讨脑恶性胶质瘤术后放化疗复发肿瘤再手术治疗的临床意义。方法选取有完整临床资料的原发恶性胶质瘤术后及其复发再手术治疗患者48例,术后同步放和(或)化疗。采用免疫荧光双染色法检测并比较脑胶质瘤干细胞(GSCs)标记物CD133/Nestin在原、复发胶质瘤中的表达,Kaplan-Meier生存分析和Cox回归风险模型分析原发术后放化疗肿瘤复发患者再次手术术前KPS评分、肿瘤体积、切除程度、GSCs数目、两次手术间隔等因素与预后的关系。结果 CD133/Nestin在原、复发恶性胶质瘤组织中阳性表达百分数分别为(3.06±0.38)%、(14.89±2.54)%,差异有统计学意义(P<0.001);单Kaplan-Meier生存分析示原发术后放和(或)疗肿瘤复发再手术术前KPS评分≥70分、肿瘤全切、肿瘤体积<50 cm3等因素显著延长患者二次术后生存时间(P<0.05);Cox回归风险模型分析表明再手术术前KPS评分、肿瘤体积、切除程度等因素可作为独立的预后因素(P<0.05)。结论脑恶性胶质瘤术后放和(或)化疗复发肿瘤富集胶质瘤干细胞,复发胶质瘤再手术治疗是靶向胶质瘤干细胞治疗的重要举措,早期积极再次手术有益于延长患者生存时间和提高生存质量。

【Abstract】 Objective To explore the clinical significance of repeat surgery for recurrent malignant gliomas after first surgical therapy combined with chemoradiotherapy.Methods The integrated clinical data of 48 patients who treated with surgical resection plus radiation and/or chemotherapy of malignant primary gliomas and underwent re-operation of recurrent tumors were collected.The co-expression of CD133 and Nestin,markers of glioma stem-like cells(GSCs),was assessed by immunofluorescence staining both in primary tumor samples and in recurrent tumor samples.Kaplan-Meier survival analysis and Cox proportional hazards regression modeling were used to estimate the prognostic value of potential prognostic factors,such as:Karnofsky performance scale(KPS)score and tumor volume before reoperation,extent of removal,CD133/Nestin co-expression and the time interval between the first and second operations.Results The percentage of GSCs was significantly higher in tissue of recurrent gliomas obtained initial surgery plus radiation and/or chemotherapy[(14.89±0.54)%]than in primary tumors[(3.06±0.38)%]as measured by double immunofluorescence staining for CD133 and Nestin(P<0.001).Kaplan-Meier survival analysis demonstrated that Karnofsky performance status(KPS)≥70 and tumor volume≤50 cm3 pre-repeat surgery,gross total resection significantly prolonged postoperative survival(P<0.05).Cox proportional hazards regression modeling revealed that KPS,tumor volume and the extent of removal were independent prognostic factors(P<0.05).Conclusions There is marked enrichment of GSCs in recurrent malignant gliomas after initial surgery followed by radiation and/or chemotherapy.This can provide evidence that reoperation in these patients may be of important application in GSCs targeting therapy.Early,aggressive repeat surgery in these cases is recommended to be of effective in prolonging survival and extending quality and quantity of life.

【基金】 河南省杰出人才计划项目(084200410011)
  • 【文献出处】 中华临床医师杂志(电子版) ,Chinese Journal of Clinicians(Electronic Edition) , 编辑部邮箱 ,2012年05期
  • 【分类号】R739.4
  • 【被引频次】25
  • 【下载频次】314
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