脑膜瘤手术后复发因素

Risk Factors of Intracranial Meningioma Relapse after Operation

目的探讨脑膜瘤手术切除后的复发因素。方法回顾分析沈阳军区总医院和上海长征医院神经外科162例手术显微镜下切除的位于静脉窦旁、镰旁、以及一些颅底脑膜瘤患者临床资料,排除凸面脑膜瘤,随访3～5年,应用单因素、多因素分析Cox模型统计学方法,分析脑膜瘤的临床特征(性别、年龄、肿瘤大小、形状)、病理分级、免疫组化指标[包括肿瘤增殖标志物Ki-67,雄激素受体(AR)、雌激素受体(ER)、孕激素受体(PR)]的表达与复发的关系。结果 53例脑膜瘤复发(复发率32.7%)。免疫组化染色结果提示AR、ER、PR、Ki-67抗体在部分脑膜瘤标本细胞核中呈阳性表达。Cox模型显示肿瘤大小、形状、病理级别和Ki67的表达与复发相关(P<0.05)。结论脑膜瘤显微镜下切除后5年内复发率较高。体积较大、不规则形态、病理Ⅱ级和Ⅲ级、Ki67表达阳性是复发的危险因素,随访时间延长复发率有增高趋势。

Objective To investigate the risk factors of intracranial meningioma relapse after gross total resection.Methods 162 meningioma patients who underwent gross total resection under the microscope,excluding those with convex tumors,were analyzed retrospectively and followed up for at least 3 years.Unifactor and multifactor Cox regression models were performed to analyze the relationships between the post-op tumor relapse and clinical characters of the patients（sex,age,tumor size,tumor shape）,pathological grade of tumor,expressions of some immunohistochemical indicators（Ki-67,AR,ER,PR）.Results There are 53 cases of recurrent meningiomas within the 5-year follow-up.The recurrent rate is about 32.7 percent.Immunohistochemical staining results indicated that expressions of AR,ER,PR and Ki-67 were positive in some tumor cell nucleuses.Cox regression analysis revealed that tumor size,tumor shape,pathological grade and Ki-67 expression were significantly correlated with the tumor relapse（P 〈 0.05）.Conclusion Our results demonstrated high recurrent rate of meningiomas after gross total resection.Tumor diameter exceeding 5 cm,irregular tumor shape,pathological grade Ⅱ and Ⅲ and positive expression of Ki-67 were the risk factors of post-op meningioma relapse.The recurrent rate increased along with the follow-up time.