[1]周兴旺 董 辉 周 桥 江 涛 刘艳辉 毛 庆.低级别胶质瘤复发再次术后癫痫预后危险因素分析[J].中国临床神经外科杂志,2016,(09):513-516.[doi:10.13798/j.issn.1009-153X.2016.09.001]
 ZHOU Xing-wang,DONG Hui,ZHOU Qiao,et al.Factors related to prognosis of seizure following reoperation for recurrent low grade gliomas[J].,2016,(09):513-516.[doi:10.13798/j.issn.1009-153X.2016.09.001]
点击复制

低级别胶质瘤复发再次术后癫痫预后危险因素分析()
分享到:

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2016年09期
页码:
513-516
栏目:
论著
出版日期:
2016-09-25

文章信息/Info

Title:
Factors related to prognosis of seizure following reoperation for recurrent low grade gliomas
文章编号:
1009-153X(2016)09-0513-04
作者:
周兴旺 董 辉 周 桥 江 涛 刘艳辉 毛 庆
610041 成都,四川大学华西医院神经外科(周兴旺、董 辉、刘艳辉、毛 庆),病理科(周 桥);100000 北京,首都医科大学天坛医院神经外科(江 涛)
Author(s):
ZHOU Xing-wang1 DONG Hui1 ZHOU Qiao2 JIANG Tao3 LIU Yan-hui1 MAO Qing1
1. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China;
3. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
关键词:
复发性低级别胶质瘤恶性转变癫痫Ki-67手术影响因素
Keywords:
Recurrent low grade glioma Risk factors Seizure Malignant transformation Ki-67
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2016.09.001
文献标志码:
A
摘要:
目的 探讨首次术后诊断为低级别胶质瘤复发并再次手术治疗后癫痫预后的危险因素。方法 回顾性分析2012年4月至2015年4月收治的复发并再次手术治疗的81例胶质瘤的临床资料。结果 81例中,43例再次术后病理诊断仍为低级别胶质瘤(无恶性转变组),38例进展为高级别胶质瘤(恶性转变组)。再次术后12个月,无恶性转变组29例(35.8%)完全无癫痫发作(EngelⅠ级),恶性转变组为26例(32.1%)。多因素Logistic 回归分析结果表明,肿瘤全切除是恶性转变组癫痫预后的良好指标(OR=0.171,95% CI为0.031~0.941,P=0.042),肿瘤全切除(OR=0.09,95% CI为0.013~0.613;P=0.014)和Ki-67低表达(OR=0.064,95% CI为0.007~0.610;P=0.017)是无恶性转变组癫痫预后良好指标,而年龄≤38岁(OR=8.899,95% CI为1.615~60.667;P=0.013)是无恶性转变组癫痫预后不良指标。结论 肿瘤全切除、年龄>38岁以及Ki-67低表达是预测复发性低级别胶质瘤术后癫痫完全控制的良好因素,而在进展为高级别的胶质瘤中,仅有肿瘤全切除有助于癫痫完全控制。
Abstract:
Objective To explore the factors relate to the prognosis seizure after reoperation for low grade gliomas diagnosed as at first. Methods The clinical data of 81 epileptic patients with low grade gliomas, who underwent surgery again for the recurrent gliomas from April, 2012 to April, 2015, were analyzed retrospectively. Results Of 81 patients with seizure before the second operation, 43 still had low grade gliomas and 38 progressively had high grade gliomas according to pathological diagnosis after the second operation. Of 55 patients in whom the seizures were completely controlled (Engel class Ⅰ) 12 months after the second surgery, 29 were ones with low grade gliomas and 26 were ones with high grade gliomas. The other patients still experienced seizures differently in degree (Engel classes Ⅱ~Ⅳ). The logistic regression analysis suggested that the risk factors related to seizure after the reoperation included incomplete resection of the tumors, high expression of Ki-67 and age less than 38 years (P<0.05) in="" the="" patients="" with="" low="" grade="" gliomas="" after="" reoperation,="" and="" risk="" factors="" related="" to="" seizure="" was="" incomplete="" resection="" of="" tumors="" high="" reoperation="" (P<0.05).>Conclusion The present Results suggested that gross total resection of the tumors, age over 38 years and low expression of Ki-67 were favorable factors related to predicting complete control of seizure in recurrent low grade glioma patients, but only the gross total resection of the tumors contributed to the complete control of seizure in the patients who experienced malignant transformation.

参考文献/References:

[1]李焕发,王 超,孟 强,等. 颞叶占位性病变伴癫痫患者 的脑电图特征及手术疗效[J]. 中国临床神经外科杂志, 2014,19:257-259.
[2] 刘长青,陈 凯,于思科,等. 颅内节细胞胶质瘤所致癫痫 的手术预后相关因素分析[J]. 中国临床神经外科杂志, 2014,19:260-262.
[3] 刘庚勋,李正贤. 癫痫相关低级别中枢神经系统肿瘤的病 理学诊断[J]. 中国临床神经外科杂志,2015,20:183-186.
[4] Riva M. Brain tumoral epilepsy: a review [J]. Neurol Sci, 2005, 26(Suppl 1): S40-50.
[5] Chang EF, Potts MB, Keles GE, et al. Seizure characteristics and control following resectionin 332 patients with low- grade gliomas [J]. J Neurosurg, 2012, 108: 227-235.
[6] Chaichana KL, Parker SL, Olivi A, et al. Long-term seizure outcomes in adult patients undergoing primary resection of malignant brain astrocytomas [J]. J Neurosurg, 2009, 111: 282-292.
[7] Yang Y, Wang X, Liu YH, et al. Ki-67 overexpression in WHO grade Ⅱ gliomas is associated with poor postopera- tive seizure control [J]. Seizure, 2013, 22(10): 877-881.
[8] You G, Sha ZY, Yan W, et al. Seizure characteristics and outcomes in 508 Chinese adult patients undergoing prima- ryresection of low-grade gliomas: a clinicopathological study [J]. Neuro Oncol, 2012, 14(2): 230-241.
[9] Liubinas SV, D’Abaco GM, Moffat BM, et al. IDH1 mutation is associated with seizures and protoplasmic subtype in patients with low-grade gliomas [J]. Epilepsia, 2014, 55(9): 1438-1443.
[10] Stockhammer F, Misch M, Helms HJ, et al. IDH1/2 muta- tions in WHO gradeⅡastrocytomas associated with locali- zation and seizure as the initial symptom [J]. Seizure, 2012, 21: 194-197.
[11] Zhong Z, Wang Z, Wang Y, et al. IDH1/2 mutation is asso- ciated with seizure as an initial symptom in low-grade gli- oma: a report of 311 Chinese adult glioma patients [J]. Epi- lepsy Res, 2015, 109: 100-105.
[12] Buckingham SC, Robel S. Glutamate and tumor-associated epilepsy: glial cell dysfunction in theperitumoral environ- ment [J]. Neurochem Int, 2013, 63(7): 696-701.
[13] Rush SZ, Abel TW, Valadez JG, et al. Activation of the He- dgehog pathway in pilocytic astrocytomas [J]. Neuro Onco, 2010, 12: 790-798.
[14] 郭熙雄,陈谦学,田道锋,等. 脑胶质瘤致癫痫因素临床分 析[J]. 中国临床神经外科杂志,2007,12(9):531-535.
[15] 欧一博,舒 凯,陈 旭,等. 颞叶低级别胶质瘤继发顽固 性癫痫的外科治疗[J]. 中国临床神经外科杂志,2009,14 (4):199-201.
[16] Berger MS, Deliganis AV, Dobbins J, et al. The effect of extentof resection on recurrencein patients with low grade cerebral hemisphere gliomas [J]. Cancer, 1994, 74(6): 1784-1791.
[17] Koekkoek JA, Dirven L, Heimans JJ, et al. Seizure reduction in a low-grade glioma: more thana beneficial side effect of temozolomide [J]. J Neurol Neurosurg Psychiatry, 2015, 86: 366-373.
[18] Yang Y, Wang X, M Qing, et al. Survival analysis for val- proicacid use in adult glioblastoma multiforme: a meta- analysis of individual patient data and a systematic review [J]. Seizure, 2014, 23(10): 830-835.
[19] Kim YH, Kim T, Joo JD, et al. Survival benefit of levetira- cetam in patients treated with concomitant chemoradiothe- rapy and adjuvant chemotherapy with temozolomide for glioblastoma multiforme [J]. Cancer, 2015, 121(17): 2926- 3932.

备注/Memo

备注/Memo:

通讯作者:毛 庆,E-mail:maoqing@scu.edu.cn
更新日期/Last Update: 2016-09-30