摘要
目的探讨成人髓母细胞瘤的临床特点、治疗方法及预后相关因素。方法对49例成人髓母细胞瘤进行生存分析寻找预后相关因素。结果手术切除47例、仅行分流术2例。术后43例行放疗，6例进行化疗。总体累积生存率为58％。平均生存时间（Kaplan-Meier法）为78个月（6．5年）。单因素生存分析显示高风险组（P=0．000）、并发症（P=0．005）、肿瘤体积〉40cm3（P=0．006）、未化疗（P=0．022）、复发／转移（P=0．000）是成人髓母细胞瘤预后不良的指标。多因素生存分析（Cox回归）显示风险分组、肿瘤体积、复发／转移是预后的独立危险因素。结论成人髓母细胞瘤治疗及预后明显不同于儿童，通过综合治疗可以达到满意疗效。
Objective To invastigate the treatment of adult with medulloblastomas and the prognosis factors. Methods Between 2004 and 2011, 49 patients who were older than 16 years old with medulloblastoma were treated consecutively in Beijing Tiantan Hospital. There were 38 men and 11 women with a mean age of 27.4±9. 3 years （ range 16 - 49 years ） . There were 20 lateral and 29 midline lesions. Patients were staged according to Chang＇s staging system. Survival analysis was performed via Kaplan-Meier and Cox regression. Results Gross total resection was achieved in 28 patients, subtotal resection in 19, and shunt only in 2 patients. 43 patients received radiotherapy postoperatively. Radiotherapy was initiated after a median duration of 16. 2 days after surgery and the median duration of radiotherapy was a 34. 3 days. 6 patients received chemotherapy. Recurrence was presented in 16 cases, the median time from diagnosis to recurrence is 25 months. After operation there were 9 patients accompanied with complications. The 4- and 8-year overall survival rates for the present study were 71% and 54%, respectively. The median overall survival time was 8 years. Univariate analysis showed that survival was significantly correlated with risk group, postoperative complications, tumor volume, chemotherapy, and recurrence/metastasis. Multivariate analysis identified risk group and tumor volumeas well as recurrence/ metastasis as independent risk factors for overall survival time. Conclusions The treatment strategy for adult with medulloblastoma are surgical resection combined with radiotherapy. Chemotherapy can be adopted in certain conditions. Long-term survival is possible in adults with medulloblastoma. Patients presented with high risk group, tumor volume lager than 40 cm3, and recurrence/metastasis have a relatively worse prognosis.
出处
《中华神经外科杂志》
CSCD
北大核心
2014年第2期170-174,共5页
Chinese Journal of Neurosurgery
关键词
成人
髓母细胞瘤
预后
生存分析
Adult
Medulloblastoma
Prognosis factors
Survival analysis
