Clinical Research On The Prognositic Factors In Patients With Glioma

PART ONEClinical factors analysis on prognosis of patients with gliomaObjectiveTo analysis the relationgship between clinical factors and prognosis in brainglioma. To supply the theoretical reference for precise judgement on the prognosisand therapeutic regimen in glioma patient.MethodsThe clinical informations of 319 primarily brain glioma patients conceivedoperation from January 1998 to december 2001. Male 173 cases, female 147 cases,male/female 1.17; age from 6 to 70 years old, average 23.8 years old. To decidetumor ambit according to CT and MRI, and cut tumor with microneurosurgeryoperation. Radiotherapy with ⁶⁰Co ray, chemotherapy with VM-26 and Me-Ccnu afteroperation. Low-grade glioma and high-grade glioma patients were fractionated total removal group and none-total removal group, nonage radiotherapy group and delayedradiotherapy group, purely radiotherapy group and therapeutic alliance group byresection extent and Postop adjunctive therapy. To decide the 1-, 3-, and 5-yearsurvival rates according to flup result. All data was analyzed with SPSS13.0 package.For the univariate analysis, survival probabilities were estimated based onKaplan-Meier's survival analysis and Logrank test. Multivariate regression analysisusing Cox's proportional-hazards model showed the simultaneous effect ofoutcome-related variables on survival. Interblock survival rate analyzed by x² test.Results1,No significant difference between sex,tumor ambit and duration of symptomsin pathology grade. On the other hand, significant difference in construction of age,KPS score,epilepsy and average live time between Low-grade glioma and high-gradeglioma.2,By single factor analysis, outcome was no significantly associated with sex,tumor ambit and duration of symptoms.And age,KPS score,epilepsy,pathologygrade have significantly associated with prognosis. By multivariate logistic regressionanalysis, only age,KPS score,pathology grade are independent risk factor toprognosis.3,Low-grade glioma patients: No significant difference between total removalcases and none-total removal cases of the 1-, 3-, and 5-year survival rates. The 1-yearsurvival rates of nonage radiotherapy group was no difference than this of delayedradiotherapy group and the 3-, 5-year survival rates was to lower. High-grade gliomapatients: The 1-, 3-, and 5-year survival rates of total removal cases was higher thanthose of none-total removal cases. The 1-, 3-, and 5-year survival rates of therapeutic alliance group was higher than those of radiotherapy group.Conclusion1,Sgnificant difference in construction of age,KPS score,epilepsy and averagelive time between different athology grade glioma. Nsogenic age older and KPS scorelower in low-grade glioma than High-grade glioma.2,No significantly associated with sex,tumor ambit,duration of symptoms andepilepsy to prognostic. Age,KPS score,pathology grade are independent risk factorto influence prognostic ofglioma patient. The glioma patients with old age,low KPSscore and high pathology grade have the more short life span.3,The surgical operation on brain glioma should reserve the premise of theimportant neurofunction for Low-grade glioma and extend the excision possibly withearly radiotherapy and chemo for high-grade glioma. Delayed radiotherapy should becarried out in low-grade glioma with the tumor relapses or grows to increase quick isproper. Therapeutic alliance was more effectively than simplicity radiotherapy withhigh-grade glioma.PART TWORelationship of GFAP and PCNA expression with pathology grade andprognosis in brain gliomaObjective To analyze the expression of GFAP and PCNA in brain glioma, and investigate therelationship with pathology grade and prognosis.MethodsThe 319 specimen with final diagnosis of brain glioma from the patients withoperation in January 1998 to december 2001. To decide the life span according to flupresult. Expression of GFAP and PCNA were examined by immunohistochemicalstaining.All data was analyzed with SPSS13.0 package. Judgement on otherness ofExpression in different pathology grade adopt rank sum test. To indicat therelationship between the expression of GFAP and PCNA and life span withKaplan-Meier curve and analyzed by Logrank test.Results1,The distribution of GFAP expression is different between gradeⅠ—Ⅱgliomaand gradeⅢ—Ⅳglioma. Masccline expression is inferior in high-grade glioma thanin low-grade glioma. The distribution of PCNA expression have significant differencebetween gradeⅠ—Ⅱglioma and gradeⅢ—Ⅳglioma. Masccline expression is strongin high-grade gliomathan in low-grade glioma.2,According to Kaplan-Meier's survival curves and log-rank test,patients withGFAP strong expression showed a longer survival time with feeble GFAP expression.Patients with PCNA strong expression showed a shorter survival time with feeblePCNA expression.Conclusion1,GFAP and PCNA expression in glioma correlates with pathology grade.GFAP expression is weaker in high-grade glioma than in low-grade glioma. PCNA expression is stronger in high-grade glioma than in low-grade glioma.3,The expression of GFAP and PCNA can evaluate the prognosis of patientswith glioma. GFAP feeble expression and PCNA potentialize expression show lowcell differentiation and high vegetative state in tumor and bad prognosis of patients.