磁共振波谱成像对胶质母细胞瘤患者早期预后的预测意义被引量：3

Predictive efficacy of magnetic resonance spectroscopy in patients with glioblastoma multiformeduring and after postoperative radiotherapy with concomitant/adjuvant temozolomide

原文传递

导出

摘要目的探讨胶质母细胞瘤（GBM）患者接受替莫唑胺（TMZ）N步放射治疗前、放射治疗结束和放射治疗后2个月肿瘤／术腔边缘和正常脑组织代谢物的变化及其对患者总生存期（os）和无进展生存期（PFS）的预测价值。方法选择中山大学附属第三医院神经外科自2011年1月至2016年1月行手术治疗、经病理证实的GBM患者，所有患者均行术后三维适形放疗，放疗期间服用TMZ，放疗结束后按照Smpp方案给予TMZ辅助化疗。放射治疗前、放射治疗结束和放射治疗后2个月时应用磁共振波谱成像（MRS）分析患者肿瘤／术腔边缘和正常脑组织代谢物N-乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）及Cho／NAA、Ch0／Cr和NAA／Cr比值的变化；比较放射治疗后2个月较放射治疗结束时标准化Cho下降〈30％、〉30％患者的生存曲线及其中位总生存期fmOS）和中位无进展生存期（mPFS）的差异。结果共有21例患者完成了预定的3次MRS扫描。研究结束时16例患者已死亡，5例患者生存。放射治疗前、放射治疗结束、放射治疗后2个月时患者肿瘤／术腔边缘标准化Cho逐渐降低（2．08±0．22、1．45±0．21、1．16±0．18），差异有统计学意义（仪0．05）。放射治疗结束时标准化Cr较放射治疗前降低，差异有统计学意义（P〈0．051。放射治疗前、放射治疗结束和放射治疗后2个月时患者肿瘤／术腔边缘Cho／NAA、Cho／Cr比值均高于正常脑组织，NA～Cr比值均低于正常脑组织，差异有统计学意义（P（O．05）。放射治疗前、放射治疗结束、放射治疗后2个月时患者肿瘤／术腔边缘Cho／NAA比值逐渐降低，差异有统计学意义（P〈0．05）。与放射治疗后2个月较放射治疗结束时标准化Cho下降〈30％的患者比较，放射治疗后2个月较放射治疗结束时标准化Cho下降〉30％的患者mPFS、mOS均较短，差异有统计学意义[4．5（3．2，6．7）vs13．5（10．1，16．8），x2=19．821，p=0．000；10，9（8.8，13．9）vs25．3（21．6，29．2），x2=22．940，p=0．000]。结论放射治疗结束、放射治疗后2个月肿瘤／术腔边缘标准化Cho的变化对GBM患者PFS、OS有较高预测意义。 Objective To explore the predictive ability of magnetic resonance spectroscopy （MRS） in overall survival （OS） and progression-free survival （PFS） of patients with glioblastoma multiforme （GBM） before, during, and 2 months after radiotherapy with concomitant/adjuvant temozolomide （TMZ）. Methods GBM patiems, admitted to our hospital from January 2011 to January 2016 and confirmed by pathology, were chosen in our study; all patients underwent postoperative three-dimensional conformal radiotherapy with concomitant/adjuvant TMZ. And 3D-MRS was performed before, during, and 2 months after radiotherapy, the levels of N-acetyl-asparfic acid （NAA）, choline （Cho）and creatine （Cr）, and ratios of Cho/NAA, Cho/Cr and NAA/Cr in the GBM/edge of surgery side and the normal brain tissues were observed. The survival curve, median overall survival （mOS） and median progression free survival （mPFS） of patients with standardized Cho decreased〈30% and patients with standardized Cho decreased〉30% 2 months after radiotherapy were compared. Results Twenty-one patients finished the scheduled MRS for 3 times. Until the end of our study, 16 patients died and 5 survived. Standardized Cho gradually decreased before, during, and 2 months after radiotherapy （2.08~ 0.22, 1.45 ~0.21 and 1.16＋0.18）, with significant differences （P〈0.05）. Standardized Cho after radiotherapy was significantly decreased as compared with that before radiotherapy （P〈0.05）. Ratios of Cho/NAA and Cho/Cr in the GBM/edge of surgery side were significantly higher than those in the normal brain tissues （P〈0.05）, and ratio of NAA/Cr in the GBMJedge of surgery side was significantly lower than that in the normal brain tissues （P〈0.05）. Ratio of Cho/NAA gradually decreased before, during, and 2 months after radiotherapy, with significant differences （P〈0.05）. As compared with patients with standardized Cho decreased〈30% 2 months after radiotherapy, patients with standardized Cho decreased〉30% 2 months after radiotherapy had significantly decreased rates of OS and PFS, and statistically shorter mI＇FS and rnOS （4.5 vs. 13.5, 10.9 vs. 25.3, P〈0.05）. Conclusion The changes of standardized Cho 2 months after radiotherapy have high prognostic significance for PFS and OS.