Clinical Features And Analysis Of Prognosis Factors Of Adult Thalamic Glioma

Objective:Thalamic glioma is one of the intracranial malignancies with the worst prognosis and highest mortality.The aim of this study was to investigate the clinical characteristics and the factors associated with tumor recurrence of adult thalamic glioma in order to improve survival time,delay recurrence and reduce mortality in thalamic glioma.Methods:A total of 55 patients who attended the Department of Neurosurgery in the First Hospital of Jilin University from 2018 to 2022,underwent surgery after hospitalization and had a postoperative pathological return confirming the diagnosis of thalamic glioma were selected.The clinical data of the patients were collected and the patients were followed up.There were 2 patients with incomplete clinical information,3 patients who were lost to follow-up,and 2 children.The final 48 patients were included in this study.One-way survival analysis of progression-free survival(PFS)was performed using Kaplan-Meier curve analysis and log-rank test.Statistically significant results from the univariate analysis were included in a multifactorial Cox proportional risk model to calculate the hazard ratio(HR)and 95%confidence interval(CI)associated with PFS and to identify independent prognostic factors.The above data were analyzed by IBM SPSS Statistics 25 to analyze the results.Results:Forty-eight patients were followed up,12 patients survived and 36 patients died.The median survival time for the whole group was 12 months,with an overall survival rate of 50%at 1 year,27.1%at 2 years,and 25.0%at 3 years.There were 26 patients aged ≥50 years and 22 patients aged<50 years.There were 27 male patients and 21 female patients.There were 26 patients with a diagnostic latency period<1 month and 22 patients with a diagnostic latency period>1 month.There were 33 patients with preoperative KPS score≥70 and 15 patients with preoperative KPS score<70.The lesions were significantly enhanced on enhanced MRI in 41 patients and not significantly enhanced in 7 patients.There were 2 patients with a history of hypertension and 46 patients without a history of hypertension.There were 3 patients with a history of smoking and 45 patients without a history of smoking.There were 3 patients with a history of diabetes mellitus and 45 patients without a history of diabetes mellitus.There were 28 patients with preoperative clinical manifestations of headache and 20 patients without significant headache.There were 19 patients with preoperative limb movement disorders and 29 patients without limb movement disorders.There were 3 patients with preoperative seizures and 45 patients without seizures.There were 17 patients with preoperative higher neurological dysfunction and 31 patients without higher neurological dysfunction.There were 24 patients with complete or largely total tumor resection and 24 patients with sub-total tumor resection.There were 20 patients with maximum tumor diameter≥4 cm and 28 patients with maximum tumor diameter<4 cm.9 patients with WHO grade Ⅱ,including 3 cases of oligodendroglioma,2 cases of ventricular meningioma,2 cases of low-grade glioma,and 2 cases of diffuse astrocytoma.11 patients with WHO grade Ⅲ,including 4 cases of mesenchymal astrocytoma,3 cases of high-grade glioma,2 cases of mesenchymal oligodendroglioma,and 2 cases of mesenchymal astrocytoma.There were 28 patients with WHO grade Ⅳ,including 22 cases of glioblastoma,4 cases of high-grade glioma,and 2 cases of diffuse midline glioma.39 of the 48 patients had high-grade glioma and 9 cases had low-grade glioma.Immunohistochemistry Ki-67>20%was performed in 20 patients and Ki-67 ≤20%in 28 patients.Twenty-two patients underwent chemotherapy after surgery,and 26 patients did not undergo chemotherapy.Twenty-five patients underwent postoperative radiotherapy and 23 patients did not undergo radiotherapy.Conclusion:Univariate analysis revealed that patient’s gender,whether the lesion was significantly enhanced on enhanced MRI,history of hypertension,whether the patient had preoperative physical mobility impairment,degree of surgical resection,whether radiotherapy was administered postoperatively,degree of glioma malignancy,and WHO classification were factors affecting the prognosis of thalamic glioma.Multifactorial analysis revealed that gender,preoperative physical impairment,degree of surgical resection,and tumor malignancy were independent prognostic factors affecting the prognosis of thalamic glioma.Patients who were male,did not have preoperative physical activity impairment,had complete surgical resection of the tumor,and had low malignancy of the glioma had better survival outcomes.