35例颅内血管外皮细胞瘤预后的临床分析
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摘要
目的:探讨总结中枢神经系统血管外皮细胞瘤(HPCs)临床治疗效果和预后。方法:回顾性分析35例HPCs的病例资料,均在显微镜下完成手术治疗,通过统计学方法分析影响其预后的关键因素。结果:所有患者确诊HPC后平均存活时间是82.4个月,1年,5年,10年总存活率分别为100%,93.8%和72.4%。13例(37.1%)患者首次手术后肿瘤复发。复发的平均时间是65.4个月,1年,5年,10年肿瘤无进展生存率分别为99%,49%,31%。3例患者发生颅外转移。患者接受任何形式的放射治疗与未接受放射治疗的患者相比,均没有延长总存活时间(P=0.22),但延长了肿瘤无进展生存时间(P=0.04)。肿瘤直径≥6 cm和肿瘤侵犯静脉窦的患者比肿瘤直径<6 cm和未侵犯静脉窦的复发更早(P<0.05)。结论:手术切除联合放疗可以阻止肿瘤进展,但不能延长患者总存活率。最大程度的肿瘤切除可以提高患者总存活率(P<0.05)。间变型HPC患者总存活率低,肿瘤无进展生存时间短(P<0.05)。
Objective: To explore and summarize efficacy in treatment and prognosis of intracranial hemangiopericytomas( HPCs). Methods: Clinical data of 35 cases of HPCs in the central nervous system were analyzed retrospectively. All surgeries were performed under microscope and the critical factors which affect prognosis of HPCs were studied by statistical analysis. Results: The median survival for all patients was 82. 4 months after date of diagnosis,with 1-year,5-year,10-year survival rates of 100%,93. 8% and 72. 4%,respectively. Thirteen patients had HPCs recurrence. The median time of recurrence was 65. 4 months,with 1-year,5-year and 10-year progression-free survival rates of 99%,49%,31%. Three patients developed extracranial metastasis. Patients undergoing any form of adjuvant radiation treatment had no longer overall survival( P = 0. 22),but had a significantly improved progression-free interval( P = 0. 04). Tumor characteristics associated with earlier recurrence included size ≥6 cm and sinus invasion. Conclusion: Surgeries combining adjuvant radiation with tumor resection appeared to inhibit tumor progression,but had no effect on overall survival. Greater extent of resection was related to increased overall survival( P < 0. 05).Anaplastic HPC was associated with reduced overall survival and with reduced recurrence interval( P < 0. 05).
Objective: To explore and summarize efficacy in treatment and prognosis of intracranial hemangiopericytomas( HPCs). Methods: Clinical data of 35 cases of HPCs in the central nervous system were analyzed retrospectively. All surgeries were performed under microscope and the critical factors which affect prognosis of HPCs were studied by statistical analysis. Results: The median survival for all patients was 82. 4 months after date of diagnosis,with 1-year,5-year,10-year survival rates of 100%,93. 8% and 72. 4%,respectively. Thirteen patients had HPCs recurrence. The median time of recurrence was 65. 4 months,with 1-year,5-year and 10-year progression-free survival rates of 99%,49%,31%. Three patients developed extracranial metastasis. Patients undergoing any form of adjuvant radiation treatment had no longer overall survival( P = 0. 22),but had a significantly improved progression-free interval( P = 0. 04). Tumor characteristics associated with earlier recurrence included size ≥6 cm and sinus invasion. Conclusion: Surgeries combining adjuvant radiation with tumor resection appeared to inhibit tumor progression,but had no effect on overall survival. Greater extent of resection was related to increased overall survival( P < 0. 05).Anaplastic HPC was associated with reduced overall survival and with reduced recurrence interval( P < 0. 05).
引文
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[2]Maekawa A,Kohashi K,Yamada Y,et al.A case of intracranial solitary fibrous tumor/hemangiopericytoma with dedifferentiated component[J].Neuropathology,2015,35(3):260-265.
[3]Rutkowski MJ,Jian BJ,Bloch O,et al.Intracranial hemangiopericytoma:clinical experience and treatment considerations in a modern series of 40 adult patients[J].Cancer,2012,118(6):1628-1636.
[4]Zhou JL,Liu JL,Zhang J,et al.Thirty-nine cases of intracranial hemangiopericytoma and anaplastic hemangiopericytoma:a retrospective review of MRI features and pathological findings[J].Eur J Radiol,2012,81(11):3504-3510.
[5]Damodaran O,Robbins P,Knuckey N,et al.Primary intracranial haemangiopericytoma:comparison of survival outcomes and metastatic potential in WHO grade II and III variants[J].J Clin Neurosci,2014,21(8):1310-1314.
[6]Kumar N,Kumar R,Kapoor R,et al.Intracranial meningeal hemangiopericytoma:10 years experience of a tertiary care Institute[J].Acta Neurochirurgica,2012,154(9):1647-1651.
[7]Ecker RD,Marsh WR,Pollock BE,et al.Hemangiopericytoma in the central nervous system:treatment,pathological features,and long-term follow up in 38 patients[J].J Neurosurg,2003,98(6):1182-1187.
[8]Melone AG,Delia A,Santoro F,et al.Intracranial hemangiopericytoma our experience in 30 years:a series of 43 cases and review of the literature[J].Word Neurosurg,2014,81(3-4):556-562.
[9]Chen LF,Yang Y,Yu XG,et al.Multimodal treatment and management strategies for intracranial hemangiopericytoma[J].J Clin Neurosci,2015,22(4):718-725.
[10]Xu BT,Qi ST,Wang HX,et al.Clinical characteristics and treatment of intracranial hemangiopericytomas[J].Chin J Neurosurg,2014,30(8):792-795.
[11]Tian RF,Liu BY,Hao SY,et al.Prognostic analysis of recurrent hemangiopericytoma in the central nervous system[J].Chin J Neurosurg,2013,29(1):41-44.
[12]Ghia AJ,Allen PK,Mahajan A,et al.Intracranial hemangiopericytoma and the role of radiation therapy:a population based analysis[J].Neurosurgery,2013,72(2):203-209.
[13]Pang H,Yao Z,Ren Y,et al.Morphologic patterns and imaging features of intracranial hemangiopericytomas:a retrospective analysis[J].Onco Targets Ther,2015,8:2169-2178.