摘要
目的分析岛叶低级别胶质瘤术后癫痫改善的影响因素及预后影响因素。方法回顾性分析2008年7月~2014年6月中国脑胶质瘤基因组图谱计划(CGGA)数据库中120例伴有术前癫痫发作症状的岛叶低级别胶质瘤病人的临床资料,随访其术后1年的癫痫发作控制情况及生存预后信息,使用Logistic多因素回归分析影响术后癫痫发作的危险因素,采用Kaplan-Meier曲线分析术后癫痫控制情况对病人无进展生存期和总生存期的影响。结果术前癫痫发作表现为单纯局灶性发作癫痫36例(30.0%),局灶性癫痫伴有不同程度的认知障碍53例(44.2%),全身性发作31例(25.8%)。手术治疗1年后随访,72例(60%)病人癫痫症状得到了完全改善(EngelⅠ级),33例(27.5%)得到了显著改善(EngelⅡ级),11例(9.2%)得到了有意义的改善(EngelⅢ级),无改善或恶化(EngelⅣ级)者4例(3.3%)。较大的肿瘤切除程度、未累及壳核、IDH1突变是癫痫术后控制的有利因素。癫痫发作的改善是无进展生存期和总生存期的有利预后因素。结论癫痫是岛叶胶质瘤最常见的临床症状,术后癫痫症状的改善与肿瘤切除程度、是否累及壳核及IDH1突变状态相关,癫痫症状完全改善有助于延长病人的复发时间和总生存时间。
Objective To explore the influencing factors and prognosis of epilepsy after operation for insular low⁃grade gliomas.Methods The clinical data of 120 patients with insular low⁃grade gliomas with pre⁃operative seizure symptoms in the Chinese glioma Genome Atlas Project(CGGA)database from July 2008 to June 2014 were retrospectively analyzed.The seizure control and survival prediction information of the patients were followed up one year after operation.The risk factors affecting post⁃operative seizures were analyzed by Logistic multiple factor regression analysis,Kapla⁃Meier curve was used to analyze the effect of postoperative epilepsy control factors on progression free survival(PFS)and overall survival(OS).Results Before operation,36 cases(30.0%)had simple focal seizures,53 cases(44.2%)had focal seizures with different degrees of cognitive impairment,and 31 cases(25.8%)had generalized seizures.During the follow⁃up after one year of surgical treatment,72 patients(60%)had a complete improvement in epilepsy symptoms(Engel gradeⅠ),33 patients(27.5%)had a significant improvement(Engel gradeⅡ),11 patients(9.2%)had a significant improvement(Engel gradeⅢ),and 4 patients(3.3%)had no improvement or deterioration(Engel gradeⅣ).Larger tumor resection degree,no putamen involved,IDH1 mutation are favorable factors for postoperative control of epilepsy.Improvement of seizures was a favorable prognostic factor for PFS and OS.Conclusion Epilepsy is the most common symptom of insular gliomas.The improvement of postoperative epilepsy symptoms is related to the degree of tumor resection,involvement of putamen and IDH1 mutation status.Complete improvement of epilepsy symptoms can prolong the progression free survival time and overall survival time of patients.
作者
史攀杰
王永恒
韩英杰
赵建华
韩志光
韩莹
SHI Panjie;WANG Yongheng;HAN Yingjie;ZHAO Jianhua;HAN Zhiguang;HAN Ying(Department of Faculty of Surgery,The First Hospital of Qinhuangdao,Hebei,Qinhuangdao 066000,China)
出处
《临床外科杂志》
2023年第11期1023-1026,共4页
Journal of Clinical Surgery
