联合影像学征象的胶质母细胞瘤患者治疗后复发的危险因素分析

Analysis of Risk Factors for Post-Treatment Recurrence in Glioblastoma Patients Incorporating Imaging Signs

摘要: 目的：探讨联合影像学征象的胶质母细胞瘤(GBM)患者标准治疗后复发的危险因素。方法：回顾性分析2017年10月至2023年12月就诊于本院并行标准治疗的113例GBM患者，根据随访结果分为疾病进展组(DP组，60例)和疾病稳定组(SD组，53例)。收集患者临床基线资料、病理分子征象(IDH突变状态、MGMT启动子甲基化状态、Ki-67阳性率)及术前MRI影像学征象(肿瘤位置、直径、强化方式等)。采用单因素及多因素Logistic回归分析GBM患者肿瘤复发的相关危险因素。结果：单因素分析显示，总随访时间(OR = 0.93, P < 0.001)、IDH突变状态(OR = 0.37, P = 0.023)、MGMT启动子甲基化(OR = 3.56, P = 0.001)及脑膜受侵(OR = 1.92, P = 0.008)与疾病进展显著相关。多因素分析进一步证实MGMT未甲基化(OR = 3.40, P = 0.004)、脑膜受侵(OR = 2.10, P = 0.005)为独立危险因素。影像学征象中，DP组颞叶占比更高(43.3% vs 24.5%, P = 0.031)，且环形强化更常见(63.3% vs 43.4%, P = 0.014)。结论：MGMT未甲基化、脑膜受侵及颞叶定位是GBM复发的独立危险因素，而长期随访可能有效检测进展。联合临床、分子及影像学征象可优化复发风险评估，为个体化治疗提供依据。

Abstract: Objective: To investigate the risk factors for recurrence in glioblastoma (GBM) patients after standard treatment by incorporating imaging signs. Methods: A retrospective analysis was conducted on 113 GBM patients who received standard treatment at our hospital from October 2017 to December 2023. Based on follow-up results, patients were divided into a disease progression group (DP group, n = 60) and a stable disease group (SD group, n = 53). Clinical baseline data, pathological molecular features (IDH mutation status, MGMT promoter methylation status, Ki-67 positivity rate), and preoperative MRI imaging signs (tumor location, diameter, enhancement patterns, etc.) were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with tumor recurrence. Results: Univariate analysis showed that total follow-up time (OR = 0.93, P < 0.001), IDH mutation status (OR = 0.37, P = 0.023), MGMT promoter methylation (OR = 3.56, P = 0.001), and meningeal invasion (OR = 1.92, P = 0.008) were significantly associated with disease progression. Multivariate analysis further confirmed that MGMT unmethylation (OR = 3.40, P = 0.004) and meningeal invasion (OR = 2.10, P = 0.005) were independent risk factors. Regarding imaging signs, the DP group had a higher proportion of temporal lobe involvement (43.3% vs. 24.5%, P = 0.031) and more frequent ring enhancement (63.3% vs. 43.4%, P = 0.014). Conclusion: MGMT unmethylation, meningeal invasion, and temporal lobe localization are independent risk factors for GBM recurrence, while long-term follow-up may effectively monitor progression. The integration of clinical, molecular, and imaging signs can optimize recurrence risk assessment and provide a basis for individualized treatment.