背景:原发性胶质肉瘤是一种罕见的恶性中枢神经系统(CNS)肿瘤,对其预后决定因素和有效治疗干预措施的理解有限。
方法:回顾性分析唐都医院2011年3月至2023年6月诊断为胶质肉瘤患者的病历资料。有神经胶质瘤病史或接受术前放化疗的患者被排除在外。使用Kaplan-Meier和Cox回归分析进行生存分析。
结果:共有77例患者纳入最终分析,中位年龄为57岁(范围13-83)。导致诊断的主要症状是头痛,颞叶是受影响最频繁的部位。单因素分析显示年龄≤65岁,完全切除,Ki67≤25%,术后Karnofsky表现状态(KPS)≥70,坚持Stupp方案,复发后的其他积极治疗与生存率提高相关.此外,多变量分析确定完全切除,年龄≤65岁,Stupp方案治疗,复发后积极治疗是总生存期(OS)的独立预测因子.值得注意的是,1例患者在治疗期间出现皮下转移.
结论:本研究结果表明,原发性神经胶质肉瘤的最佳治疗需要最大限度的安全切除,联合替莫唑胺辅助放疗和化疗,在复发的情况下进行抢救治疗。然而,在治疗过程中应仔细监测转移的风险。
BACKGROUND: Primary gliosarcoma is a rare form of malignant central nervous system (CNS) tumor, with limited understanding regarding its prognostic determinants and effective therapeutic interventions.
METHODS: The medical records of patients diagnosed with gliosarcoma at Tangdu Hospital between March 2011 and June 2023 were retrospectively analyzed in this
study. Patients with a prior history of glioma or those who received preoperative chemoradiotherapy were excluded. Survival analyses were conducted using Kaplan-Meier and Cox regression analysis.
RESULTS: A total of 77 patients were included in the final analysis with a median age of 57 years (range 13-83). The predominant symptom leading to diagnosis was headache, and the temporal lobe was the most frequently affected site. Univariate analysis revealed that age ≤ 65 years, complete resection, Ki67 ≤ 25%, postoperative Karnofsky Performance Status (KPS) ≥ 70, adherence to the Stupp protocol, and additional active therapy upon relapse were associated with enhanced survival. Furthermore, multivariate analysis identified complete resection, aged ≤ 65 years, Stupp protocol treatment, and active therapy following relapse were independent predictors of overall survival (OS). Notably, one patient experienced subcutaneous metastasis during treatment.
CONCLUSIONS: The present
study\'s findings suggest that optimal management of primary gliosarcoma entails maximal safe resection, combined with adjuvant radiotherapy and chemotherapy with temozolomide, followed by salvage therapy in case of recurrence. However, the risk of metastases should be carefully monitored during the treatment course.