Analysis Of Related Factors Of Postoperative Recurrence For High Grade Glioma

Objective: To explore the factors related to postoperative recurrence of high grade glioma,and to provide some help for the prognosis of glioma.In addition,it will provide more theoretical basis for the postoperative treatment of high grade glioma patients.Methods: The clinical data of 150 patients with postoperative high-grade glioma were retrospectively analyzed at the Affiliated Hospital of Qingdao University.All patients were confirmed by pathology after operation.To understand the gender,age,preoperative KPS score,preoperative seizures,extent of resection,tumor pathological grade,postoperative radiotherapy and chemotherapy,tumor molecular marker IDH1 mutation status,Ki-67 expression level.There were 82 males and 68 females;aged ≤ 50 years 84 cases,> 50 years old in 66 cases;according to WHO classification,grade III glioma 84 cases,grade IV glioma in 66 cases;postoperative chemotherapy patients 38 Cases,no chemotherapy in 112 cases;postoperative radiotherapy in 44 cases,106 cases were not receive radiotherapy.Tumor molecular marker IDH1 wild type 86 cases,IDH1 mutant type 64 cases.The patients were followed up by medical records and telephone.Patients were treated with three-dimensional conformal radiotherapy(3D-CRT)or intensity modulated radiotherapy(IMRT).Postoperative chemotherapy was treated with temozolomide(TMZ).Patients were followed up for disease recurrence.The time of recurrence after surgery was defined as the time interval that the first time of glioma resection to the recurrent lesions were found by regular imaging.The relationship between the factors and the time of recurrence was analyzed by SPSS software.P <0.05 was regarded as the statistical standard.First,the t-test was used to understand the average recurrence time of each index.According to the postoperative recurrence rate,the chi-square test was used for univariate analysis of screening factors associated with postoperative recurrence.Finally,multivariate logistic stepwise regression analysis was used to obtain the independent influencing factors of postoperative recurrence in patients with high grade glioma.The correlation between age,tumor pathological grade,IDH1 mutation status and Ki-67 expression levels was analyzed using the Spearman correlation test.Results: Postoperative recurrence was that the average recurrence time was 11.97 months for patients ≤ 50 years old,while in the age group> 50 years old was 7.46 months(P<0.05).The average recurrence time was 12.07 months for patients with seizures before surgery,patients without seizures was 9.12 months(P<0.05).The average recurrence time was 13.20 months for patients with radiotherapy,patients without radiotherapy was 8.65 months(P<0.05).The average recurrence time was 14.62 months for patients with chemotherapy,patients without chemotherapy was 8.41 months(P<0.05).The average recurrence time of patients with IDH1 mutation was 13.42 months,IDH1 wild-type patients was 7.42 months(P<0.05).Ki-67 positive rate of ≤ 25% of patients with an average recurrence time of 12.13 months,while Ki-67 positive rate of > 25% of patients was 8.38 months(P<0.05).The results of univariate analysis showed age(P<0.05),preoperative seizures(P = 0.0076),tumor pathological grade(P <0.05),postoperative radiotherapy(P <0.05),postoperative chemotherapy(P<0.05)and the mutant state of the molecular marker IDH1(P<0.05)was statistically significant.Multivariate logistic stepwise regression analysis showed that age(P < 0.05),postoperative radiotherapy(P < 0.05),postoperative chemotherapy(P < 0.05),IDH1 mutation status(P<0.05)were independent factors of postoperative recurrence for high grade glioma patients.The correlation analysis showed that the age of the patients was positively correlated with the pathological grade of the tumor(r = 0.2965,P<0.05).The pathological grade of the tumor was positively correlated with the expression level of Ki-67(r = 0.5599,P<0.05).IDH1 mutation status was negatively correlated with the expression level of Ki-67(r =-0.3932,P<0.05).Conclusion: Patients who were> 50 years old,who did not receive radiotherapy and chemotherapy after surgery,tumor molecular marker IDH1 wild type are independent risk factors for postoperative recurrence in patients with high grade glioma.The gender,preoperative KPS score,preoperative seizures,extent of resection,tumor pathological grade and the expression level of Ki-67 had no significant effect on postoperative recurrence.Postoperative radiotherapy and chemotherapy with temozolomide can delay the recurrence of the disease.Therefore,in the treatment and prognosis judgment of high grade glioma,the need to fully understand the general condition of patients,taking into account the various factors on the impact of patients,focusing on age,postoperative radiotherapy,postoperative chemotherapy and expression of tumor molecular markers.To give the most reasonable and optimized treatment,delay the recurrence of high grade glioma to improve the prognosis of patients.