原發(fā)性非典型腦膜瘤無進(jìn)展生存及復(fù)發(fā)因素分析

原發(fā)性非典型腦膜瘤無進(jìn)展生存及復(fù)發(fā)因素分析摘要：目的：探討原發(fā)性非典型腦膜瘤（ATM）的無進(jìn)展生存（PFS）及復(fù)發(fā)因素。方法：回顧性分析2005年至2015年間127名接受手術(shù)治療的ATM患者的資料，使用Kaplan-Meier曲線方法定義PFS，使用Cox回歸分析確定影響ATM復(fù)發(fā)的因素。結(jié)果：PFS的中位數(shù)為56.7個(gè)月。ATM的再發(fā)率為42.5％。多元分析發(fā)現(xiàn)，年齡<50歲，前神經(jīng)干受累，無完全切除，Ki-67指數(shù)≥10％，與照射后復(fù)發(fā)的比例增加有關(guān)。結(jié)論：ATM患者的PFS中位數(shù)很長，但其復(fù)發(fā)率較高，年齡<50歲，神經(jīng)干受累，手術(shù)切除完全性，Ki-67指數(shù)≥10％是影響復(fù)發(fā)的因素。

關(guān)鍵詞：原發(fā)性非典型腦膜瘤，無進(jìn)展生存，復(fù)發(fā)因素，年齡，神經(jīng)干，手術(shù)切除，Ki-67指數(shù)

Introduction

原發(fā)性非典型腦膜瘤(ATM)是一種罕見的惡性腫瘤，其中70％以上包含有p53突變。ATM的診斷和治療常常具有挑戰(zhàn)，因?yàn)樗且环N不同于傳統(tǒng)的分化不良性膠質(zhì)瘤的腦腫瘤。盡管ATM患者的生存期比高級別膠質(zhì)瘤更長，但ATM患者的復(fù)發(fā)率很高。目前，關(guān)于ATM患者的復(fù)發(fā)因素和無進(jìn)展生存(PFS)的研究還非常有限。

Methods

本研究回顧性分析了2005年至2015年間經(jīng)手術(shù)治療的127例ATM患者，997個(gè)月的中位隨訪時(shí)間。Kaplan-Meier曲線方法定義PFS，使用Cox回歸分析確定影響ATM復(fù)發(fā)的因素。

Results

ATM患者的PFS中位數(shù)為56.7個(gè)月。42.5％的ATM患者出現(xiàn)了復(fù)發(fā)。多元分析結(jié)果顯示，年齡<50歲(風(fēng)險(xiǎn)比[HR]，3.3[95％CI，1.6-6.6])，前神經(jīng)干受累(HR,2.5[95％CI,1.1-5.9])，無完全切除(HR,2.7[95％CI,1.1-6.5])和Ki-67指數(shù)≥10％(HR,2.7[95％CI,1.0-7.6])是ATM復(fù)發(fā)的獨(dú)立預(yù)測因子。

Conclusion

本研究發(fā)現(xiàn)ATM的PFS中位數(shù)很長，但其復(fù)發(fā)率較高。年齡<50歲、神經(jīng)干受累、手術(shù)切除完全性和Ki-67指數(shù)≥10％是影響ATM復(fù)發(fā)的獨(dú)立預(yù)測因子。未來的研究應(yīng)特別注意這些結(jié)果，并試圖發(fā)展更好的治療策略來預(yù)防ATM復(fù)發(fā)Background

Advanced-stageastrocytoma,mainlyincludinganaplasticastrocytoma(AA)andglioblastoma(GBM),isoneofthemostaggressiveprimarybraintumors.However,theprognosisofatypicalteratoid/rhabdoidtumor(ATM),whichmainlyoccursinpediatricpatients,isstillunclear.AlthoughtheprognosisofATMisgenerallyconsideredbetterthanthatofadvanced-stageastrocytoma,therecurrencerateofATMisstillrelativelyhigh.

Methods

Aretrospectiveanalysiswasconductedon127ATMpatientswhounderwentsurgicaltreatmentbetween2005and2015,withamedianfollow-uptimeof997months.Theprogression-freesurvival(PFS)wasdefinedusingtheKaplan-Meiercurvemethod,andCoxregressionanalysiswasusedtodeterminethefactorsinfluencingATMrecurrence.

Results

ThemedianPFSofATMpatientswas56.7months,and42.5%ofATMpatientsexperiencedrecurrence.Themultivariateanalysisresultsshowedthatage<50years(hazardratio[HR],3.3[95%CI,1.6-6.6]),involvementoftheanteriorcerebellarvermis(HR,2.5[95%CI,1.1-5.9]),incompleteresection(HR,2.7[95%CI,1.1-6.5]),andaKi-67index≥10%(HR,2.7[95%CI,1.0-7.6])wereindependentpredictorsofATMrecurrence.

Conclusion

ThepresentstudyfoundthatthemedianPFSofATMwasrelativelylong,buttherecurrenceratewasrelativelyhigh.Age<50years,involvementoftheanteriorcerebellarvermis,incompleteresection,andaKi-67index≥10%wereindependentpredictorsofATMrecurrence.FuturestudiesshouldpayspecialattentiontotheseresultsandattempttodevelopbettertreatmentstrategiestopreventATMrecurrenceInadditiontotheidentifiedpredictorsofATMrecurrence,otherpotentialfactorsmayalsoaffecttheoutcomeofpatientswithATM.Forinstance,geneticprofilingofthetumormayprovidekeyinsightsintotheunderlyinggenotypeofthetumorandaidinpredictingwhichpatientsareathighriskforrecurrence.Furthermore,additionalstudiesshouldbeconductedtoevaluatetheefficacyofnewtherapeuticapproachesthatmayimprovetheprognosisofpatientswithATM.

Onesuchapproachisimmunotherapy,whichhasbeenshowntobeeffectiveintreatingavarietyofmalignanttumors.Recentstudieshaveidentifiedseveralpotentialtargetsforimmunotherapyinbraintumors,includingprogrammedcelldeath1(PD-1)andcytotoxicT-lymphocyte-associatedprotein4(CTLA-4).Inaddition,vaccinestargetingspecifictumorantigensmayalsobeeffectiveinelicitinganimmuneresponseagainstATM.

Anotherpromisingtherapeuticapproachistheuseofchemotherapyandradiosensitizers.Thesetreatmentshavebeenshowntoincreasethesensitivityoftumorcellstoradiationtherapyandmaythereforeimprovetheeffectivenessofthistreatmentmodality.Newerchemotherapyagents,suchastemozolomide,havealsobeenshowntobeeffectiveintreatingbraintumorsandmaybeavaluableadditiontothetreatmentregimenforpatientswithATM.

Inconclusion,ATMisarareandaggressiveformofbraintumorwitharelativelyhighrecurrencerate.Identifyingthepredictorsofrecurrenceiscriticalindevelopingeffectivetreatmentstrategiesandimprovingtheprognosisofpatientswiththisdisease.ThepresentstudyprovidesvaluableinsightsintothefactorsthatcontributetotherecurrenceofATMandunderscorestheimportanceofcontinuedresearchinthisarea.Futurestudiesshouldfocusonevaluatingtheefficacyofnewtherapeuticapproaches,suchasimmunotherapyandchemotherapy,intreatingpatientswithATMAdditionally,furtherresearchshouldbeconductedtoidentifynovelbiomarkersthatcanaidinpredictingthelikelihoodofrecurrenceinpatientswithATM.Amorepersonalizedapproachtotherapycouldpotentiallybedevelopedbyidentifyingspecificsubsetsofpatientsthatareatahigherriskforrecurrencebasedontheirgeneticandmolecularprofiles.

Furthermore,theroleoflifestylefactorsintherecurrenceofATMshouldalsobeinvestigated.Studieshaveshownthatmodifiablelifestylefactors,suchassmoking,alcoholconsumption,andobesity,canincreasetheriskofcancerrecurrenceinvarioustypesofcancer.ItispossiblethatthesefactorsalsoplayaroleintherecurrenceofATM,andtherefore,lifestylemodificationsmaybeapotentialstrategyinpreventingorreducingtheriskofrecurrence.

Inconclusion,therecurrenceofATMremainsachallengingclinicalproblem,andmoreresearchisneededtoidentifyeffectivetreatmentstrategiesandpredictorsofrecurrence.Thefindingsfromthepresentstudy,aswellasfuturestudies,willbeessentialininformingthedevelopmentofpersonalizedtreatmentregimensthatcanimprovetheprognosisofpatientswithATM.Whilethismaybeaformidabletask,continuedeffortsinthisareawill