TERTp和1p/19q对顺铂联合替莫唑胺同期放化疗治疗MGMT启动子未甲基化GBM的预后影响

摘要

To investigate the clinical characteristics and prognostic value of TERTp and 1p／19q phenotype in DDP +TMZ concurrent chemoradiotherapy for newly diagnosed GBM with unmethylated MGMT promoter.Methods A retrospective analysis was made in 73 newly diagnosed GBM with unmethylated MGMT promoter.All patients received DDP+TMZ.The aim of this study was to analyze the clinical characteristics , adverse reactions, PFS and OS of patients with different TERTp and 1p／19q groups.Results According to TERTp, there were 30 cases of TERTp wt and 43 cases of TERTp mut.According to 1p／19q, 62 cases were non-deletion and 11 cases were deletion.There was no significant difference in clinical parameters between two groups (P＞0.05). Up to 31st January 2019, 44 patients had recurrence , 17 with TERTp wt and 27 with TERTp mut. The median PFS was 12.0 and 10.0 months, respectively.The 1-year PFS rate was 33.6% and 27.2%.22 patients died, 9 with TERTp wt and 13 with TERTp mut.The median OS was 20.0 and 19.0 months.The 1-year OS rate was 77.9% and 73.2%.There were 38 recurrences in 1p／19q non-deletion and 6 recurrences in deletion.The median PFS was 10.0 and 22.0 months respectively.The 1-year PFS rate was 20.4%and 60.0%.There were 19 deaths with 1p／19q non-deletion, 3 deaths in deletion, and the median OS was 18.0 and 23.0 months.The 1-year OS rates were 60.3%and 88.9%.There was a better trend in the efficacy for 1p／19q non-deletion than that of deletion.But the difference was not significant.Conclusion The efficacy of TERTp wt is slightly higher than that of TERTp mut.The efficacy of 1p／19q deletion group is higher than that of non-deletion, but the difference is not statistically significant.1p／19q may have potential prognostic value in newly diagnosed GBM with unmethylated MGMT promoter receiving DDP +TMZ concurrent chemoradiotherapy, which deserves further study.%目的 探讨TERTp和1p／19q不同表型对DDP联合TMZ同期放化疗治疗新诊断 MGMT启动子未甲基化GBM的预后影响.方法 回顾性分析73例新诊断MGMT启动子未甲基化的GBM的临床资料,均接受DDP联合TMZ同期放化疗,行TERTp和1p／19q检测,分析TERTp和1p／19q不同表型的临床特征、副反应、PFS和OS.结果 根据TERTp分为TERTp wt 30例和TERTp mut 43例,根据1p／19q分为无缺失组62例和缺失组11例,临床资料差异均无统计学意义( P＞0.05).截至2019 年1 月31 日,44 例复发,其中TERTp wt 17例、TERTp mut 27例,中位PFS为12.0个月和10.0个月,1年PFS率为33.6%和27.2%. 22例死亡,其中TERTp wt 9 例、TERTp mut 13 例,中位OS 为20.0 个月和19.0 个月,1 年 OS 率为77.9%和73.2%,差异无统计学意义. 1p／19q无缺失组复发38例,缺失组复发6例,中位PFS为10.0个月与22.0个月, 1年PFS率为20.4%和60.0%,差异无统计学意义. 1p／19q无缺失组死亡19例,缺失组死亡3例,中位OS为18.0个月和23.0个月;1年OS率为60.3%和88.9%. 1p／19q缺失组疗效有高于无缺失组的趋势,但差异无统计学意义.结论 DDP联合TMZ同期放化疗治疗MGMT启动子未甲基化新诊断GBM,TERTp wt疗效略高于TERTp mut,1p／19q缺失组疗效有高于无缺失组的趋势,但差异未达到统计学意义. 1p／19q可能在MGMT启动子未甲基化新诊断GBM接受DDP联合TMZ同期放化疗中有潜在的影响预后价值,值得进一步研究.