肿瘤切除程度对脑胶质瘤光动力治疗后脑水肿及预后的影响

李婧萱, 闫秀伟, 胡韶山

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重庆医科大学学报 ›› 2024, Vol. 49 ›› Issue (09) : 1163-1170. DOI: 10.13406/j.cnki.cyxb.003577
临床研究

肿瘤切除程度对脑胶质瘤光动力治疗后脑水肿及预后的影响

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Influence of the degree of tumor resection on cerebral edema and prognosis after photodynamic therapy for gliomas

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摘要

目的 使用光动力疗法（photodynamic therapy，PDT）辅助显微手术的综合治疗可以有效改善恶性脑胶质瘤患者的预后，提高生存率。本研究将探讨肿瘤的不同切除程度对高级别胶质瘤PDT后脑水肿及预后的影响。 方法 对2020年1月至2022年12月浙江省人民医院进行PDT辅助显微手术的高级别胶质瘤患者进行回顾性病例对照研究，收集患者基线资料和生存数据，对比肿瘤的不同切除程度对高级别胶质瘤PDT后脑水肿及预后的影响。 结果 近全切除组纳入30例，次全切除组纳入26例进行分析。通过统计发现，接受光动力辅助近全切除的患者术后脑水肿程度更低（16.67%的近全切除组患者出现Ⅲ级脑水肿，50%的次全切除组患者出现Ⅲ级脑水肿，P=0.011），其无进展生存期（progression free survival，PFS）（近全切除组15.63个月vs. 次全切除组8.36个月，P=0.002 5）也明显优于接受光动力辅助次全切除的患者。近全切除组患者生存质量更高（近全切除组患者的生存质量评分明显大于次全切除组，术后3个月P<0.001，术后6个月P=0.002）。 结论 光动力疗法辅助近全切除的综合治疗方式可显著降低高级别胶质瘤患者术后脑水肿程度，有助于提高患者术后生存质量、抑制肿瘤的复发以及延长患者的总生存期。

Abstract

Objective To investigate the influence of different degrees of tumor resection on cerebral edema and prognosis after photodynamic therapy（PDT） for high-grade glioma，since multimodality therapy with PDT and microsurgery can effectively improve the prognosis and survival rate of patients with malignant glioma. Methods A retrospective case-control study was conducted for the patients with high-grade glioma who underwent PDT and microsurgery in Zhejiang Provincial People’s Hospital from January 2020 to December 2022，and baseline data and survival data were collected from all patients. The influence of different degrees of tumor resection on cerebral edema and prognosis after PDT for high-grade glioma was analyzed and compared. Results There were 30 cases in the near-total resection group and 26 cases in the subtotal resection group. The statistical analysis showed that the patients receiving photodynamic-assisted near-total resection had a lower degree of postoperative cerebral edema（16.67% of the patients in the near-total resection group developed grade Ⅲ cerebral edema，and 50% of the patients in the subtotal resection group developed grade Ⅲ cerebral edema，P=0.011），as well as significantly better progression-free survival than those receiving photodynamic-assisted subtotal resection（15.63 months vs. 8.36 months，P=0.0025）. The patients in the near-total resection group had a better quality of life，and the near-total resection group had a significantly higher quality of life score than the subtotal resection group （three months after surgery： P<0.001；six months after surgery：P=0.002）. Conclusion The multimodality therapy with PDT and near-total resection can significantly reduce the degree of cerebral edema in patients with high-grade glioma and help to improve postoperative quality of life，inhibit tumor recurrence，and prolong the overall survival of patients.

关键词

胶质瘤 / 光动力 / 近全切除 / 次全切除 / 脑水肿

Key words

glioma / photodynamic therapy / near-total resection / sub-total resection / cerebral edema

中图分类号

R61 / R64

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李婧萱 , 闫秀伟 , 胡韶山. 肿瘤切除程度对脑胶质瘤光动力治疗后脑水肿及预后的影响. 重庆医科大学学报. 2024, 49(09): 1163-1170 https://doi.org/10.13406/j.cnki.cyxb.003577
Li Jingxuan, Yan Xiuwei, Hu Shaoshan. Influence of the degree of tumor resection on cerebral edema and prognosis after photodynamic therapy for gliomas[J]. Journal of Chongqing Medical University. 2024, 49(09): 1163-1170 https://doi.org/10.13406/j.cnki.cyxb.003577

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基金

2022年浙江省人民医院杰出领军人才资助项目(C-2022-YYJCLJRC01)

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