Study Of Survival Of Insular Glioma Patients And Spatial Conformation Between Tumor And Fiber Bundles

Background and objective:Complexity of the location of insular glioma, being adjacent to the important blood vessel and nerve fiber bundle and strong invasiveness of glioma itself all make it extremely feasible to cause dysfunction of the patients, and difficult to achieve complete surgical excision. The first part is to explore the factors that affect the survival time of insular glioma patients, and how to improve survival rate and achieve low-complication. The second part is to explore the factors affecting the function of insular glioma patients by studying the relationship between tumors and the white matter fiber bundles around insula, and early predictors for the recovery of patients'nerve function.Methods:The first part:236 cases of insular glioma patients were included, and the impact of gender, sides, number of lobes, pathological grade, surgical approach (iMRI group and navigation group), the extent of tumor resection, the expression of MGMT, radiotherapy, temozolomide(TMZ) cycle (6 cycles or long-term) on the progression free survival time (PFS) and survival time (OS) was statistically analyzed to explore whether these factors have significant impacts on PFS and OS and which factor was most closely related. The second part:Finish the reconstruction the 3D model of the arcuate fasciculus, pyramidal tract and optic radiation by DTI technique, and measurement of tumor volume (V), diameter (D) and the shortest distance between tumors and the white matter fiber bundle (Dmin) respectively. t test was used to compare the difference between normal group and abnormal group, ROC curve was used to screen the most sensitive indictors predicting the function of the patients and Spearman rank was used to screen the early predictors for the recovery of patients'nerve function.Results:First part:The intraoperative group has longer OS and PFS than navigation group (PFS:p=0.001; OS:p=0.001); PFS and OS of the high degree of resection of tumors were significantly prolonged (PFS:p=0.001; OS:p=0.001), and iMRI can significantly improve the degree of resection of tumors (p=0.001); The OS and PFS for different pathological grades patients are statistically different with reverse correlation (PFS:p= 0.001; OS:p=0.001), and the degree of expression of Ki-67 has a positive correlation with the pathological grade; The OS and PFS of the patients receiving more than six cycles temolozomide are both significantly longer than that of six cycles (PFS:p=0.001; OS:p=0.001); the expression of MGMT has significant impact on overall survival (p=0.001), and Low expression of MGMT can improve the sensitivity of insular glioma patients to TMZ; radiotherapy can prolong the PFS of the patients(p=0.018).second part: V, D, Dmin about the pyramidal tract has a significant influence on the patient's motor function(D:p=0.04; V:p=0.019; Dmin:p=0.003); D and Dmin about the arcuate fasciculus has a significant influence on patient's language (V:p=0.035; Dmin:p=0.008). D and Dmin about the optic radiation is statistically signifiacnt to the patient's vision; ROC curve showed that Dmin of the three kinds of fiber bundle has a relative higher efficiency and sensitivity in predicting the nerve function of insular glioma patients, the increase of the volume of arcuate fasciculus and pyramidal tract after the operation has statistical significance in predicting early neurological changes in the patients after operation (arcuate fasciculus p=0.001, r=0.929; pyramidal tract:p=0.008, r=0.805).Conclusion:First part:1.Pathological grade, surgical approach (iMRI group and navigation group), the extent of tumor resection, the expression of MGMT, TMZ cycle (6 cycles or long-term) is the independent factors of PFS and OS of the insular glioma patients.2.The expression of Ki-67 was positively correlated with the extent of the pathological grades; 3.Low expression of MGMT can improve the sensitivity of glioma patients to TMZ. Second part:1. For insular glioma patients, tumor volume (V), diameter (D) and the shortest distance between tumors and the white matter fiber bundle (Dmin),in which the Dmin has the highest sensitivity, all can significantly affect patients' nerve function and the patients are more vulnerable to have dysfunction when Dmin was under critical value.2.The increase of the volume of the arcuate fasciculus and pyramidal tract after the operation and preoperative FA can be adopted as early predictors for the recovery of patients'nerve function.