天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (12): 1290-1294.doi: 10.11958/20252243

• 临床研究 • 上一篇    下一篇

影响IDH野生型胶质母细胞瘤预后的多因素分析

杨燕(), 杨万福, 李海亮, 杨治花()   

  1. 宁夏医科大学总医院放疗科（邮编750004）
  • 收稿日期:2025-06-12 修回日期:2025-09-04 出版日期:2025-12-15 发布日期:2025-12-08
  • 通讯作者: △E-mail：shirley99081999@163.com
  • 作者简介:杨燕（1986），女，主治医师，主要从事恶性肿瘤放射治疗方面研究。E-mail：631745056@qq.com

Multivariate analysis of factors influencing prognosis in IDH wild-type glioblastoma

YANG Yan(), YANG Wanfu, LI Hailiang, YANG Zhihua()   

  1. Department of Radiation Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, China
  • Received:2025-06-12 Revised:2025-09-04 Published:2025-12-15 Online:2025-12-08
  • Contact: △E-mail：shirley99081999@163.com

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摘要：

目的 分析异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤（GBM）患者临床病理特征及预后的影响因素。方法 回顾性分析2014年1月—2024年7月宁夏医科大学总医院经病理确诊的137例GBM患者，收集患者年龄、性别、民族，是否有癫痫、神经功能受损，放疗前卡氏功能状态（KPS）评分，肿瘤切除程度、肿瘤侧别、肿瘤位置、肿瘤最大径、IDH突变状态、Ki-67指数、MGMT启动子甲基化信息、术后同步放化疗情况和辅助化疗周期。多因素Cox回归分析GBM患者预后的影响因素；Kaplan-Meier生存曲线比较不同临床特征GBM患者生存情况。结果 137例GBM患者的中位生存时间为20.9个月，其1年、2年、3年生存率分别为79.7%、36.9%、16.4%。放疗前KPS评分、MGMT启动子是否甲基化、术后是否同步放化疗及辅助化疗周期数对GBM患者中位生存期有影响（P<0.05）。多因素Cox回归分析显示，MGMT启动子未甲基化、术后未同步放化疗及辅助化疗周期数<6个是GBM患者生存的独立危险因素（P<0.05）。放疗前KPS评分<80分、MGMT启动子未甲基化、术后未同步放化疗、辅助化疗周期数<6个患者的累积总生存率分别低于放疗前KPS评分≥80分、MGMT启动子甲基化、术后同步放化疗和辅助化疗周期数≥6个的患者（P<0.05）。结论 MGMT启动子未甲基化、术后未同步放化疗及辅助化疗周期数<6个是影响IDH野生型GBM患者生存期的独立危险因素。??

关键词: 胶质母细胞瘤, 异柠檬酸脱氢酶, O（6）-甲基鸟嘌呤DNA甲基转移酶, 启动区, 遗传, 甲基化, 放化疗, 辅助

Abstract:

Objective To investige clinicopathological features and prognostic factors in patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM). Methods A total of 137 patients with GBM diagnosed by surgical pathology at the General Hospital of Ningxia Medical University from January 2014 to July 2024 were retrospectively enrolled in this study. Clinical data, including age, gender, ethnicity, presence of epilepsy, neurological function status and Karnofsky Performance Status (KPS) score prior to radiotherapy, were collected. Tumor-related parameters, such as extent of resection, histological classification, tumor location, maximum tumor diameter, IDH mutation status, Ki-67 proliferation index, methylation status of the O6-methylguanine-DNA methyltransferase (MGMT) promoter and postoperative treatment regimens—including concurrent chemoradiotherapy and the number of adjuvant chemotherapy cycles were also recorded. Multivariate Cox proportional hazards regression analysis was conducted to identify independent prognostic factors. Kaplan-Meier survival curves were used to evaluate overall survival according to clinical characteristics. Results The median overall survival (OS) of the 137 GBM patients was 20.9 months, and their 1-year, 2-year and 3-year survival rates were 79.7%, 36.9% and 16.4%, respectively. Pre-radiotherapy KPS score, MGMT promoter methylation status, receipt of postoperative concurrent chemoradiotherapy and the number of adjuvant chemotherapy cycles were significantly associated with median survival of GBM patients (P<0.05). Multivariate Cox analysis revealed that absence of MGMT promoter methylation, lack of postoperative concurrent chemoradiotherapy after surgery and the number of adjuvant chemotherapy cycles<6 were independent risk factors for reduced survival in patients with GBM (P<0.05). Patients with a pre-radiotherapy KPS score<80, MGMT promoter unmethylation, lack of postoperative concurrent chemoradiotherapy and the number of adjuvant chemotherapy cycles<6 demonstrated significantly lower cumulative overall survival rates compared to those with these characteristics (P<0.05). Conclusion MGMT promoter unmethylation, lack of postoperative concurrent chemoradiotherapy and adjuvant chemotherapy cycles<6 are independent risk factors affecting overall survival in patients with IDH wild-type GBM.

Key words: glioblastoma, isocitrate dehydrogenase, O(6)-methylguanine-DNA methyltransferase, promoter regions, genetic, methylation, chemoradiotherapy, adjuvant

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