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摘要


目的:本研究探討腦內惡性神經膠質瘤之病患,其存在之特殊變異因子,對於治療預後之影響。 材料與方法:本研究共搜集了自民國74年4月至民國84年4月間,於馬偕紀念醫院,經手術後診斷為腦內惡性神經膠瘤之42位病患。其中17位患有退行性星狀細胞瘤,另25位病人患有多型性膠質母細胞瘤。這些病患皆接受術後放射線治療。研究針對17位臨床因子及2項組織學因子,包括年齡、性別、出現頭痛、精神改變、癲病、視力改變、運動能力缺失、感覺改變、言語困難、術前行為狀態、開刀範圍、術後放射治療劑量、腦水腫、腦中腺移動、血腫形成、腫瘤部位、症狀持續時間、組織學分期及腫瘤囊腫形成,分析這些因子對於存活期評估的重要性。 結果:本研究分析之總中值存活期為18.7月,退行性星狀細胞瘤病患之中值存活期為25.4月,多型性膠質母細胞瘤病患之中值存活期為14.2月。分析結果利用Cox multivariate regession model 及 Chisquare test 顯示,組織分期、手術切除之範圍、年齡、性別及病患表現頭痛和運動機能缺失,皆會影響治療之預後。 結論:經由研究分析出惡性神經膠質瘤之預後參數,可利用來作為病患之分組治療。針對不同預後因子,提供病患更合適之治療。

並列摘要


Aim: Despite recent advances in neuro-imaging, neurosurgieal techniques, and aggressive approach using combined modalities, the prognosis for patients with malignant gliomas remains dismal. The goal of this study was to increase our understanding of the relative influence that specific variables have on the outcome of patients. Methods and Materials: Forty-two patients with intracranial malignant gliomas (17 with anaplastic astrocytomas and 25 with glioblastoma multiforme), treated by surgery and postoperative radiotherapy at Mackay Memorial Hospital from April 1985 through April 1995, were retrospectively reviewed. Twenty-six men and 16 women with a median age of 44 years (range, 10 to 70 years) were entered in the study. Seventeen clinical factors (age at surgery; sex; initial presenting symptoms of headaches, mental changes, seizure, visual changes, motor deficits, sensory changes, and speech difficulties; preoperative performance status based on the Karnofsky scale; the extent of surgical removal; postoperative radiotherapy dose; the presence of brain edema, brain midline shift, and hematoma formation; tumor she; duration of initial symptoms), and 2 histological factors (histological grade; tumor cystic formation) were analyzed to investigate their importance in predicting length of survival. Data were analyzed using the Cox proportional harzards analysis or Chi-square test. Results: The overall median survival time was 18.7 months. The median survival time was 25.4 months for anaplastic astrocytoma and 14.2 months for glioblastoma multiforme Four pretreatment variables including histological grade, age, sex and the extent of tumor resection (subtotal or total) were found to have a statistically significant effect on survival when analyzed together by the Cox multivariate regression model. Univariate analysis by the Chi-square test identified the presenting neurological symptoms of mental changes and motor deficits as having an adverse effect on survival. Conclusions: The authors conclude that histological grade, age, sex, extent of tumor resection, and the presenting symptoms of mental changes or motor deficits were important prognostic parameters in malignant gliomas. By stratifying patients into more homogeneous subgroups with favorable or unfavorable prognostic factors, treatment can be specially tailored for different subgroups.

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