非典型脑膜瘤显微手术治疗后复发的影响因素分析

Risk factors associated with postoperative recurrence in atypical meningioma

目的探讨非典型脑膜瘤(AMs)患者术后肿瘤复发的相关影响因素。方法回顾性分析广州医科大学附属肿瘤医院61例AMs患者的临床资料及随访资料,其中男31例,女30例,中位年龄55岁,均行显微手术切除。术后行三维适形放射治疗(3D-CRT)或放疗联合替莫唑胺化疗,其中放疗组43例,无放疗组18例。采用Kaplam-Meier进行生存分析,Log-rank进行差异性检验,多因素Cox回归分析评估肿瘤复发的相关因素。结果61例AMs患者随访6~162月,复发28例,死亡9例,中位无进展生存时间(PFS)48个月,5年PFS 41.0%,5年总生存时间(OS)54.1%。单因素分析显示,肿瘤形状、瘤周脑水肿、脑侵袭、静脉窦侵袭、肿瘤切除程度和增殖指数(Ki67)≥10%与肿瘤术后复发相关(均P<0.05);术后放疗或放疗联合替莫唑胺化疗对PFS无显著影响(P>0.05)。多因素分析显示,脑侵袭、SimpsonⅡ-Ⅳ切除和Ki67≥10%的AMs患者术后复发的风险增加(均P<0.05)。结论AMs治疗以手术切除为主,术后放疗或放疗联合替莫唑胺化疗不能改善患者的PFS。脑侵袭、肿瘤手术切除程度和Ki67≥10%是肿瘤复发独立的影响因素。

Objective To explore the relevant risk factors of postoperative tumor recurrence in patients with atypical meningiomas(AMs).Methods The clinical data and survival data of 61 AMs patients from the Affiliated Cancer Hospital and Institute of Guangzhou Medical University were retrospectively analyzed,including 31 males and 30 females with a median age of 55 years.All patients underwent microsurgical resection.Three-dimensional conformal radiation therapy(3D-CRT)or radiotherapy combined with temozolomide chemotherapy were performed after surgery.There were 43 cases in the radiotherapy group and 18 cases in the non-radiotherapy group.Kaplam-meier survival analysis,Log-rank difference test,and multivariate Cox regression analysis were used to evaluate the related factors of tumor recurrence.Results Sixty-one patients were followed up for 6-162 months,of which 28 recurred and 9 died.The median progression-free survival(PFS)was 48 months,5-year PFS was 41.0%and 5-year overall survival(OS)was 54.1%.Univariate analysis showed that tumor shape,peritumoral cerebral edema,brain invasion,sinus invasion,tumor resection degree and proliferation index(Ki67)≥10%were correlated with tumor recurrence(all P<0.05).Postoperative radiotherapy or radiotherapy combined with temozolomide chemotherapy had no statistical difference on PFS(P>0.05).Multivariate analysis showed that AMs patients with brain invasion,Simpson gradeⅡ-Ⅳresection and Ki67≥10%had an increased risk of postoperative recurrence(all P<0.05).Conclusion The treatment of AMs is mainly surgical resection.Postoperative radiotherapy or radiotherapy combined with temozolomide chemotherapy cannot improve patients’PFS.Brain invasion,Ki67≥10%and tumor resection were independent prognostic factors.