Study Of Clinical Prognostic Factors And Therapy Of Recurrent Intracranial Glioma

PURPOSE: Glioma is the most common intracranial malignancy neoplasm. Little clinical research data of recurrent glioma were reported, and farther clinical investigation and follow-up survival data are needed to guide the treatment of recurrent glioma. To explore the effective treatment model by the analysis of clinical data and follow-up survival informations of recurrent glioma sufferers is the aim of the study.MATERIAL: 50 cases with complete records and histological conformed recurrent glioma sufferers treated in neurosurgery department of second affiliated hospital Zhejiang university college of medicine from 2002-2006 were followed up, merged and analyzed.METHOD: Information gathering and follow-up approach: These cases's records were offered by medical records library of second affiliated hospital Zhejiang University college of medicine. Related clinical data and contact ways of the cases were gathered. The follow-up was carryied out mainly by telephone. All informations were inputed into sheet.Statistical method: Univariate analysis was processed by Kaplan-Meier method. Take post-recurrent survival time and overal survival time as interactional variables to analyze the effect of thirty-eight variables from clinic data, imaging characteristics and pathohistology records on survival time. Log-rank method was used to test significance of variables with p<0.05 as the statistically significant interaction on survival time. Multivariate analysis:Multivariate analysis COX regression model was done with these variables. All the informations were analyzed by "spssl3. 0for windows edition" .RESULT: The median survival time of the group is 20.50 months, and the post-recurrent median survival time is 6.00 months. Univariate analysis showed that: age of onset (P=0. 002) , tumour size preopration (P=0. 007) , tumor site(P=0. 014),relief time post-operation(P=0. 001), complications of first operation (P=0. 038) and operative treatment after recurrent(P=0. 004) were associated with post-recurrent survival time. Multivariate analysis shows that: operative treatment after recurrent(P=0. 016, regression coefficient: —0. 594, relative risk:0. 552) , primary tumour site(P=0. 039, regression coefficient:0. 103, relative risk:1. 109), age of onset(P=0. 046, regression coefficient:0. 025, relative risk: 1. 026) and complications of first operation (P=0. 040, regression coefficient: 1.077, relative risk:2. 937) were the independent prognostic factors of the post-recurrent survival time. The following items were associated with duration from onset to die (overal course of diseases, overal survival time): Univariate analysis shows that: age of onset(P=0. 010),preoperative Karnofsky performance status (P=0. 024) , duration from onset to visit(P=0. 004) , duration from onset to operation (P=0. 002) , tumour size(P=0. 043) , tumor site (P=0. 000) , WHO pathological grade (P=0. 013) , complications of first operation (P=0. 042) , relief status post-operation(P=0. 002) , relief time post-operation (P=0. 000) , radiothearpy post-operation (p=0. 034) , duration from onset to recurrent (p=0. 000) and duration from operation to recurrent (p=0. 000) were significant prognostic factors of overal survival time. Multivariate analysis shows that the following variables were independent variables of overal surval time: WHO pathological grade (P=0. 028, regression coefficient: 1. 941, relative risk:6. 967), tumour site(P=0. 035, regression coefficient:0.175, relative riskr:1.191) , preoprative Karnofsky performance status (P = 0.020,regression coefficient:3.257, relative risk:25. 971) , duration from onset to first operation(p=0. 028, regression coefficient: —1. 467,relative risk: 0. 231), delaied time from onset to visit (p=0. 002, regression coefficient: -2.558, relative risk:0. 077), relief time post operation (P=0. 002, regression coefficient:—0. 272, relative risk:0. 762) and duration from onset to recurrent (P=0. 016, regression coefficient:—0. 320, relative risk:0. 726) .The mean post-recurrent survival time was 9.200±10.4959 months, and overal survival time for average was 25. 500+31. 3325 months, there were obvious significant difference between the two groups of data examed by t-test (P=0. 000) .The mean recurrent survival time of the re-operative treated group was 13.292±13.0800 months, while the non-reoperative treated group was 5.423 ±5.2549 months (p=0. 0003) CONCLUSION: Brain glioma with bad prognosis, and the WHO pathological grade higher, the prognosis worse; Glioma sufferers's recurrent survival time is obviously shorter than duration from onset to recurrent time, and the prognosis of recurrent glioma sufferers is very poor; Re-operative treatment can benifit for the recurrent survival time after recurrent, and the survival advantage is about 8 months in average. Re-radiotherapy and re-chemotherapy after recurrent showed little benifit for the recurrent patients.