Clinical Study On Risk Factors And Prognostic Factors Of Glioma-related Epilepsy

Objective:The incidence of epilepsy in patients with glioma is high,and the occurrence of epilepsy has brought serious adverse effects on the quality of life and prognosis of patients with glioma.The purpose of this study is to explore the risk factors of epilepsy in patients with glioma and the related factors affecting the prognosis of epilepsy after glioma surgery,in order to provide a better comprehensive treatment for patients with glioma-related epilepsy(GRE),so as to improve their quality of life.Methods:The clinical data of glioma patients treated in the first affiliated Hospital of Guangxi Medical University from January 2006 to June 2020 were analyzed retrospectively.The diagnosis of all patients was confirmed by operation or biopsy pathology.According to the occurrence of preoperative epilepsy,they were divided into glioma with epilepsy group and glioma without epilepsy group.All patients with preoperative glioma were divided into a well-controlled epilepsy group and a poorly controlled epilepsy group according to Engel’s criteria.The collected information included the clinical data of the patients,including age,imaging features(such as tumor location,shape,size,cystic degeneration,necrosis,enhancement,space occupying effect,midline shift,edema,calcification,etc.),pathological type,WHO grade,immunohistochemical features(such as Ki-67 expression rate,MGMT,EMA and p53,etc.),degree of tumor resection,postoperative seizure remission,the use and types of anti-epileptic drugs(AEDs),recurrence and so on.To analyze the relationship between the above indexes and the occurrence of preoperative epilepsy and postoperative epilepsy prognosis of glioma.Results:Among the 302 patients included,there were 187 male patients and115 female patients,including male patients aged from 18 to 75 years old,with an average age of 48.72 ± 13.115,and female patients with onset age from 19 to75 years old,with an average age of 45.86 ± 13.583.There were 75 patients with epilepsy and 227 patients of non-epilepsy.The course of epilepsy before operation was 6 days to 8 years.After operation,30 patients(58.8%)reached Engel I,4(7.8%)reached Engel II,8(15.7%)reached Engel III,and 9(17.6%)reached Engel IV.Univariate analysis showed that age(< 38 years old),tumor diameter,tumor morphology,cystic degeneration,enhancement,midline shift,space occupying effect,pathological type,WHO grade,low expression of Ki-67,EMA and p53 expression were important factors of epilepsy(p<0.05).Tumor location,necrosis,calcification,peritumoral edema,growth across the midline,expression of GFAP and MGMT and the occurrence of epilepsy were not statistically significant(p>0.05).The age(≥ 45 years old)and p53 expression were significantly correlated with the prognosis of postoperative epilepsy(p<0.05).The course of epilepsy,seizure pattern,tumor resection range,WHO grade,low expression of Ki-67,EGFR and MGMT expression,types of AEDs were not statistically significant in the postoperative epilepsy prognosis(p >0.05).The results of multivariate analysis showed that tumor diameter was an important predictor of preoperative epilepsy,the smaller the tumor diameter,the higher the incidence of preoperative epilepsy(OR=0.288,95%CI=0.109-0.755,p=0.011),and p53 was an important predictor of postoperative epilepsy prognosis,and the lower the expression rate of p53,the higher the probability of poor control of postoperative epilepsy(OR=0.093,95%CI=0.011-0.733,p=0.028).Conclusions:Tumor diameter,that is,tumor growth rate,is an independent influencing factor for GRE.Its diagnostic efficacy for epilepsy is moderate.The smaller the tumor diameter,the higher the incidence of epilepsy;p53 is a good control of epilepsy after GRE.The higher the expression rate of p53,the higher the probability of good postoperative epilepsy control.