成人室管膜瘤的临床病理特征及预后因素分析

葛荣 李征 周新成 陈金平 刘创峰

[摘要] 目的 探討成人室管膜瘤的临床病理特征和预后的相关因素。 方法 回顾性分析宁波市临床病理诊断中心2011年7月1日至2020年6月1日诊断的56例成人室管膜瘤患者的临床和病理资料。采用Kaplan-Meier法分析患者的生存预后，应用单因素分析和COX回归分析探讨患者生存期的影响因素。 结果 56例患者中，男26例，女30例，年龄18～76岁，平均49.3岁。肿瘤位于幕上13例，幕下12例，脊髓31例。初次手术45例获得全切除，11例行次全切除。术后接受放疗25例，化疗18例。随访3年和5年总生存率分别为87.3%和83.1%，3年和5年无进展生存率分别为62.7%和52.7%。单因素和多因素分析结果表明，肿瘤发生部位（HR=5.890，P=0.047）、Ki-67阳性指数（HR=8.576，P=0.039）、手术切除程度（HR=0.073，P=0.007）和术后放疗（HR=0.080，P=0.041）是患者总生存期的独立影响因素。 结论 对于成人室管膜瘤患者，肿瘤位于幕上，Ki-67指数高，预后较差;手术切除是最有效的治疗手段，肿瘤切除程度与生存期相关;术后积极放疗可以提高疗效。

[关键词] 成人;室管膜瘤;临床病理特征;预后因素

[中图分类号] R739.4          [文献标识码] B          [文章编号] 1673-9701（2021）35-0138-04

Analysis of clinicopathological characteristics and prognostic factors of adult ependymoma

GE Rong   LI Zheng   ZHOU Xincheng   CHEN Jinping   LIU Chuangfeng

Ningbo Clinical Pathology Diagnostic Center，Ningbo   315021，China

[Abstract] Objective To investigate the clinicopathological characteristics and prognostic factors of adult ependymoma. Methods The explore and pathological data of 56 adult patients with ependymoma diagnosed by Ningbo Clinical Pathology Center from July 1， 2011 to June 1， 2020 were retrospectively analysed. Kaplan-Meier method was used to analyze the survival prognosis of patients， and univariate analysis and COX regression analysis were used to explore the influencing factors of patients' survival. Results Among the 56 patients， 26 were males and 30 were females，aged 18-76 years， with an average age of 49.3 years. There were 13 cases of supratentorial tumors，12 cases of infratentorial tumors， and 31 cases of spinal cord tumors. Total resection was achieved in 45 cases for the first operation， and subtotal resection was performed in 11 cases. 25 cases received postoperative radiotherapy and 18 cases received chemotherapy. The 3-year and 5-year overall survival rates were 87.3% and 83.1%，respectively. The 3-year and 5-year progression-free survival rates were 62.7% and 52.7%， respectively. The results of univariate and multivariate analysis showed that tumor site（HR=5.890，P=0.047），Ki-67 positive index（HR=8.576， P=0.039）， degree of surgical resection（HR=0.073，P=0.007） and postoperative radiotherapy（HR=0.080， P=0.041） were independent factors influencing the overall survival of patients. Conclusion For adult patients with ependymoma， supratentorial tumors with a high Ki-67 index have a poor prognosis. Surgical resection is the most effective treatment， and the degree of tumor resection is related to survival. Postoperative radiotherapy can improve the efficacy.

[Key words] Adults; Ependymoma; Clinicopathological characteristics; Prognostic factors

室管膜瘤起源于脑室系统或脊髓中央管的室管膜细胞，约占所有脑肿瘤的2%[1]。任何年龄均可发病，但儿童更常见，0～19岁年龄组占所有中枢神经系统（Central nervous system，CNS）肿瘤的5.2%[2]。室管膜瘤按照组织学形态分为Ⅰ～Ⅲ级，然而，组织学分级能否预测室管膜瘤的预后一直存在争议[3]。最近，一些研究尝试运用全基因组甲基化技术对肿瘤进行分型，根据解剖学部位（幕上、幕下和脊髓）及分子学特征将室管膜瘤进一步分类，从而识别肿瘤生物遗传学、临床病程和预后的潜在差异[4]。……