Objective To evaluate the effect of temozolomide plus radiotherapy in the treatment of glioblato-ma, and to investigate the possible influence factors of the prognosis. Methods Two hundred and eighty-seven glioblastoma patients undergoing debulking surgery from August 2006 to March 2011 were randomized into two groups according to the proportion of 0.9/1: the radiotherapy group (n=136) and radiotherapy plus temozolomide group (n= 151). The overall survival and progression-free survival after 2 years of both groups were compared with Cox propo-tional-hazard models. Results During the follow-up of 2 years, the median survival was 14.8 months in the radiotherapy plus temozolomide group and 11.7 months in the radiotherapy group. The mortality risk in the radiotherapy plus temozolomide group was 0.53 (95% CI 0.41-0.67; P<0.01). The progression-free survival was 6.8 months in the radiotherapy plus temozolomide group and 4.9 months in the radiotherapy group. The extent of surgery showed obvious correlation with the survival. The mortality risk decreases 0.64 (95%CI 0.54-0.73), respectively, from biopsy to partial resection, mostly resection, total resection. Conclusion Temozolomide plus radiotherapy for glioblastoma can prolong the survival duration, and the extent of surgery exerts decisive influence on the prognosis.%目的 评价替莫唑胺联合放疗治疗胶质母细胞瘤的临床效果及相关影响因素.方法 采用前瞻性随机对照方法,对2006年8月至2011年3月287例符合纳入标准的胶质母细胞瘤患者,按0.9:1随机分为放疗组136例,替莫唑胺+放疗组151例.Kaplan-Meier生存曲线法分析两组患者2年总体生存时间及无复发生存时间.采用COX风险比例模型,纳入年龄、性别、手术切除范围、小型精神状态量表评分、WHO体力状况评分等,评价两放疗组患者死亡风险率,同时比较单个影响因素间相对死亡风险.结果 随访2年后,替莫唑胺+放疗组中位生存期14.8个月,放疗组11.7个月.替莫唑胺+放疗组调整死亡风险率为0.53 (95％CI 0.41～0.67;P＜0.01).替莫唑胺+放疗组无复发中位生存期6.8个月,放疗组4.9个月.手术切除程度与生存时间有明确关系(P＜0.01)；从活检及部分切除到大部分切除再到次全切,死亡风险依次下降0.64 (95％CI 0.54～0.73).结论 替莫唑胺联合放疗能明显延长患者术后生存时间,手术切除程度仍对该类患者预后有决定性影响.
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