非典型脑膜瘤38例疗效及预后因素分析
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摘要
目的探讨非典型脑膜瘤治疗疗效及影响预后相关因素。方法回顾性分析38例非典型脑膜瘤患完整的临床资料及随访资料,均行外科切除术,并参照2007年WHO脑肿瘤分类中非典型脑膜瘤病理诊断标准确诊,其中男14例,女24例,年龄31~72岁,中位年龄53.5岁,手术前KPS评分40~90分,中位KPS 80分;凸面脑膜瘤21例,颅底脑膜瘤5例,大脑镰旁和矢状窦旁脑膜瘤10,其他2例;SimpsonⅠ级切除15例,SimpsonⅡ级切除9例,SimpsonⅢ级切除6例,SimpsonⅣ级切除8例;术后行3D-CRT放疗12例,处方剂量Dt 50~60 Gy中位Dt 54 Gy。采用Kaplam-Meier进行生存分析,log-rank进行差异性检验。结果截至2017年4月,38例患者随访16~108个月,中位随访时间24.5个月,随访期间6例复发,2例死亡;全组中位无进展生存时间(PFS)66个月,5年PFS 53.3%,5年OS 80.0%;单因素分析结果患者PFS与性别(女vs男,P=0.023)、年龄(年龄<50岁vs年龄≥50岁,P=0.034)、Simpson分级(SimpsonⅠ级vsⅡ~Ⅳ级,P=0.028)相关,而与KPS(KPS≥80 vs KPS<80,P=0.338)、病灶位置(凸面vs非凸面,P=0.201)、术后放疗(放疗vs非放疗,P=0.456)无关。结论非典型脑膜瘤治疗依然以外科手术为主,女性、年龄<50岁、SimpsonⅠ级切除为延长PFS有利因素,但术后辅助放疗并未改善PFS。
Objective To assess the prognosis and potential predictable factors for patients with atypical meningiomas( AMs). Methods A total of 38 patients with AMs were retrospective analyzed. All the tumors were underwent surgical resection and were pathologically confirmed. Fourteen of them were males with a median age of 53. 5 years( range,31-72 years). And 21 cases were convex meningiomas,5 were basal skull meningiomas. Simpson grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ resection were achieved in 15,9,6,and 8 cases,respectively. Three-dimensional conformal radiation therapy was applied in 12 cases postoperatively,with a median Dt of 54 Gy( 50-60 Gy). Results The median follow-up time was 24. 5 months( range,16 ~ 108 months). Six patients relapsed and 2 died at the last follow-up. The median progression-free survival( PFS) was 66 months,5-year PFS ` and 5-year overall survival( OS) were 53. 3% and80. 0%,respectively. In univariate analysis,sex( P = 0. 023),age( P = 0. 034) and Simpson grade( P = 0. 028) were significantly correlated with PFS. Conclusion Surgical resection remains the main method to treat AMs. Female,younger age and Simpson I resection were associated with favorable prognosis. However,postoperative adjuvant radiotherapy did not improve PFS. The conclusions of the present study warranted further research to confirm.
Objective To assess the prognosis and potential predictable factors for patients with atypical meningiomas( AMs). Methods A total of 38 patients with AMs were retrospective analyzed. All the tumors were underwent surgical resection and were pathologically confirmed. Fourteen of them were males with a median age of 53. 5 years( range,31-72 years). And 21 cases were convex meningiomas,5 were basal skull meningiomas. Simpson grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ resection were achieved in 15,9,6,and 8 cases,respectively. Three-dimensional conformal radiation therapy was applied in 12 cases postoperatively,with a median Dt of 54 Gy( 50-60 Gy). Results The median follow-up time was 24. 5 months( range,16 ~ 108 months). Six patients relapsed and 2 died at the last follow-up. The median progression-free survival( PFS) was 66 months,5-year PFS ` and 5-year overall survival( OS) were 53. 3% and80. 0%,respectively. In univariate analysis,sex( P = 0. 023),age( P = 0. 034) and Simpson grade( P = 0. 028) were significantly correlated with PFS. Conclusion Surgical resection remains the main method to treat AMs. Female,younger age and Simpson I resection were associated with favorable prognosis. However,postoperative adjuvant radiotherapy did not improve PFS. The conclusions of the present study warranted further research to confirm.
引文
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[8]Lagman C,Bhatt NS,Lee SJ,et al.Adjuvant Radiosurgery Versus Serial Surveillance Following Subtotal Resection of Atypical Meningioma:A Systematic Analysis[J].World Neurosurg,2017,98:339-346.
[9]Bagshaw HP,Burt LM,Jensen RL,et al.Adjuvant radiotherapy for atypical meningiomas[J].J Neurosurg,2017,126(6):1822-1828.
[10]Graffeo CS,Leeper HE,Perry A,et al.Revisiting Adjuvant Radiotherapy After Gross Total Resection of World Health Organization Grade II Meningioma[J].World Neurosurg,2017,103:655-663.
[2]李俊驹,张超才,姜中利.非典型脑膜瘤的临床分析[J].临床神经外科杂志,2016,13(4):245-251.
[3]Goyal LK,Suh JH,Mohan DS,et al.Local control and overall survival in atypical meningioma:a retrospective study[J].Int J Radiat Oncol Biol Phys,2000,46(1):57-61.
[4]Zaher A,Abdelbari Mattar M,Zayed DH,et al.Atypical meningioma:a study of prognostic factors[J].World Neurosurg,2013,80(5):549-553.
[5]Hammouche S,Clark S,Wong AH,et al.Long-term survival analysis of atypical meningiomas:survival rates,prognostic factors,operative and radiotherapy treatment[J].Acta Neurochir(Wien),2014,156(8):1475-1481.
[6]Jenkinson MD,Waqar M,Farah JO,et al.Early adjuvant radiotherapy in the treatment of atypical meningioma[J].J Clin Neurosci,2016,28:87-92.
[7]Kaur G,Sayegh ET,Larson A,et al.Adjuvant radiotherapy for atypical and malignant meningiomas:a systematic review[J].Neuro Oncol,2014,16(5):628-636.
[8]Lagman C,Bhatt NS,Lee SJ,et al.Adjuvant Radiosurgery Versus Serial Surveillance Following Subtotal Resection of Atypical Meningioma:A Systematic Analysis[J].World Neurosurg,2017,98:339-346.
[9]Bagshaw HP,Burt LM,Jensen RL,et al.Adjuvant radiotherapy for atypical meningiomas[J].J Neurosurg,2017,126(6):1822-1828.
[10]Graffeo CS,Leeper HE,Perry A,et al.Revisiting Adjuvant Radiotherapy After Gross Total Resection of World Health Organization Grade II Meningioma[J].World Neurosurg,2017,103:655-663.