非典型脑膜瘤74例临床预后分析
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摘要
目的探讨非典型脑膜瘤的术前诊断、治疗方式及预后相关影响因素。方法回顾性分析2008年至2016年青岛大学附属医院神经外科收治的74例经病理证实为非典型脑膜瘤患者的临床资料,应用Log-rank法和Cox回归进行统计分析,并结合文献对本病的特点、治疗方法和预后进行分析。结果 74例非典型脑膜瘤患者中62例全切,全切率为83.8%,36例术后进行放射治疗;中位无进展生存期(PFS)为71.8(9~110个月),2年、5年的无进展生存期(PFS)为79.5%、70.5%;总存活期(OS)为20~110个月,中位总存活期(OS)为82.2个月,2年、5年总存活期(OS)为94.5%、90.1%。单因素分析显示,首发症状为骨侵袭,增殖指数(Ki67)≥10%者的复发风险增加(P<0.05)。多因素分析显示,首发症状为骨侵袭,增殖指数Ki67≥10%者的复发风险增加(P<0.05),功能状态评分标准(KPS)≥80分患者存活时间更长(P<0.05)。结论手术切除是改善非典型脑膜瘤患者预后的最主要方法,对于未全切患者,术后建议积极放射治疗;对于手术全切者,以首发症状为偏瘫、存在骨侵袭、增殖指数(Ki67)≥10%为易复发患者,存在这些因素中的1项及以上者,推荐术后辅助放疗,放疗剂量约为50~60 Gy。
Objective The pre-operative diagnosis,treatment and prognostic factors of atypical meningiomas were discussed.Methods The clinical data of 74 cases of pathologically confirmed atypical meningioma admitted to Neurosurgical Department of Affiliated Hospital of Qingdao University from 2008 to 2016 were collected and analyzed retrospectively.All the data were processed by Log-rank method and Cox regression for statistical analysis,and the characteristics,treatment and prognosis of the disease were analyzed.Results Of all the 74 patients with atypical meningiomas,62 patients underwent total resection(83.8%) and 36 patients underwent radiotherapy.The median progression-free-survival(PFS) was 71.8(9 ~110 months),and the progression-free-survival(PFS) rate was 79.5% and 70.5% for 2 years and 5 years,respectively; overall survival(OS) was 20 ~ 110 months,the median overall survival(OS) was 82.2 months,overall survival(OS) rate for 2 years and 5 years was 94.5% and 90.1%,respectively.Univariate analysis showed that the first symptom of bone invasion and the proliferation index(Ki67) ≥10% increased the risk of recurrence(P < 0.05).Multivariate analysis showed that the initial symptom was bone invasion and the proliferation index(Ki67) ≥10% increased the risk of recurrence(P < 0.05).The patients with Karnofsky(KPS) ≥80 got a longer survival time(P < 0.05).Conclusion Surgical resection is the most important method to improve the prognosis of patients with atypical meningioma.For patients without total resection,postoperative radiotherapy is recommended.The first symptom as hemiplegia,bone attack and/or proliferation index(Ki67) ≥10% are regarded as the factors of easy recurrence for patients with total resection.If more than one factor is presented,post-operative auxiliary radiotherapy is recommended with a radiotherapy dose of 50 ~60 Gy.
Objective The pre-operative diagnosis,treatment and prognostic factors of atypical meningiomas were discussed.Methods The clinical data of 74 cases of pathologically confirmed atypical meningioma admitted to Neurosurgical Department of Affiliated Hospital of Qingdao University from 2008 to 2016 were collected and analyzed retrospectively.All the data were processed by Log-rank method and Cox regression for statistical analysis,and the characteristics,treatment and prognosis of the disease were analyzed.Results Of all the 74 patients with atypical meningiomas,62 patients underwent total resection(83.8%) and 36 patients underwent radiotherapy.The median progression-free-survival(PFS) was 71.8(9 ~110 months),and the progression-free-survival(PFS) rate was 79.5% and 70.5% for 2 years and 5 years,respectively; overall survival(OS) was 20 ~ 110 months,the median overall survival(OS) was 82.2 months,overall survival(OS) rate for 2 years and 5 years was 94.5% and 90.1%,respectively.Univariate analysis showed that the first symptom of bone invasion and the proliferation index(Ki67) ≥10% increased the risk of recurrence(P < 0.05).Multivariate analysis showed that the initial symptom was bone invasion and the proliferation index(Ki67) ≥10% increased the risk of recurrence(P < 0.05).The patients with Karnofsky(KPS) ≥80 got a longer survival time(P < 0.05).Conclusion Surgical resection is the most important method to improve the prognosis of patients with atypical meningioma.For patients without total resection,postoperative radiotherapy is recommended.The first symptom as hemiplegia,bone attack and/or proliferation index(Ki67) ≥10% are regarded as the factors of easy recurrence for patients with total resection.If more than one factor is presented,post-operative auxiliary radiotherapy is recommended with a radiotherapy dose of 50 ~60 Gy.
引文
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2 HARDESTY D A,WOLF A B,BRACHMAN D G,et al.The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection[J].J Neurosurg,2013,119(2):475-481.
3 YANG S Y,PARK C K,PARK S H,et al.Atypical and anaplastic meningiomas:prognostic implications of clinicopathological features[J].J Neurol Neurosurg Psychiatry,2008,79(5):574-580.
4 WU Q W,YAN R F,LI Q,et al.Magnetic resonance image manifestations of the atypical meningioma[J].Asian Pac J Cancer Prev,2013,14(11):6337-6340.
5 HO D M,HSU C Y,TING L T,et al.Histopathology and MIB-1labeling index predicted recurrence of meningiomas:a proposal of diagnostic criteria for patients with atypical meningioma[J].Cancer,2002,94(5):1538-1547.
6 YU S Q,WANG J S,JI N,et al.Clinical characteristics and therapeutic strategies of atypical meningioma[J].Chin Med J(Engl),2011,124(7):1094-1096.
7 殷尚炯,曹藏柱,程月飞,等.非典型脑膜瘤的生存分析[J].中华神经外科疾病研究杂志,2017,16(4):329-333.
8 NAKASU S,LI D H,OKABE H,et al.Significance of MIB-1 staining indices in meningiomas:comparison of two counting methods[J].Am J Surg Pathol,2001,25(4):472-478.
9 PASQUIER D,BIJMOLT S,VENINGA T,et al.Atypical and malignant meningioma:outcome and prognostic factors in 119 irradiated patients.A multicenter,retrospective study of the Rare Cancer Network[J].Int J Radiat Oncol Biol Phys,2008,71(5):1388-1393.
10 KLINGER D R,FLORES B C,LEWIS J J,et al.Atypical meningiomas:recurrence,reoperation,and radiotherapy[J].World Neurosurg,2015,84(3):839-845.
11 HUG E B,DEVRIES A,THORNTON A F,et al.Management of atypical and malignant meningiomas:role of high-dose,3D-conformal radiation therapy[J].J Neurooncol,2000,48(2):151-160.
2 HARDESTY D A,WOLF A B,BRACHMAN D G,et al.The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection[J].J Neurosurg,2013,119(2):475-481.
3 YANG S Y,PARK C K,PARK S H,et al.Atypical and anaplastic meningiomas:prognostic implications of clinicopathological features[J].J Neurol Neurosurg Psychiatry,2008,79(5):574-580.
4 WU Q W,YAN R F,LI Q,et al.Magnetic resonance image manifestations of the atypical meningioma[J].Asian Pac J Cancer Prev,2013,14(11):6337-6340.
5 HO D M,HSU C Y,TING L T,et al.Histopathology and MIB-1labeling index predicted recurrence of meningiomas:a proposal of diagnostic criteria for patients with atypical meningioma[J].Cancer,2002,94(5):1538-1547.
6 YU S Q,WANG J S,JI N,et al.Clinical characteristics and therapeutic strategies of atypical meningioma[J].Chin Med J(Engl),2011,124(7):1094-1096.
7 殷尚炯,曹藏柱,程月飞,等.非典型脑膜瘤的生存分析[J].中华神经外科疾病研究杂志,2017,16(4):329-333.
8 NAKASU S,LI D H,OKABE H,et al.Significance of MIB-1 staining indices in meningiomas:comparison of two counting methods[J].Am J Surg Pathol,2001,25(4):472-478.
9 PASQUIER D,BIJMOLT S,VENINGA T,et al.Atypical and malignant meningioma:outcome and prognostic factors in 119 irradiated patients.A multicenter,retrospective study of the Rare Cancer Network[J].Int J Radiat Oncol Biol Phys,2008,71(5):1388-1393.
10 KLINGER D R,FLORES B C,LEWIS J J,et al.Atypical meningiomas:recurrence,reoperation,and radiotherapy[J].World Neurosurg,2015,84(3):839-845.
11 HUG E B,DEVRIES A,THORNTON A F,et al.Management of atypical and malignant meningiomas:role of high-dose,3D-conformal radiation therapy[J].J Neurooncol,2000,48(2):151-160.