颅内间变性脑膜瘤的治疗及预后分析

Treatment and prognostic analysis of intracranial anaplastic meningioma

目的 探讨颅内间变性脑膜瘤的治疗方法及预后.方法 回顾性分析2008年1月至2013年7月首都医科大学北京电力医院-首都医科大学附属北京天坛医院神经外科合作病房接受手术治疗的51例颅内间变性脑膜瘤患者的临床资料,并分析其预后相关因素.结果 51例患者均接受手术治疗,组织病理学证实为间变性（恶性）脑膜瘤.其中46例获得随访的患者中,首次手术Simpson Ⅰ级切除24例,SimpsonⅡ、Ⅲ级切除共22例.术后并发症以肿瘤所在位置神经功能损失为主.46例随访患者中,共接受手术96次,复发37例,复发率为80％,2年复发率为52％.无进展生存期（PFS）为2～73个月,中位数为24个月.46例随访患者中Simpson Ⅰ级切除合并放疗组12例,Ⅰ级切除无放疗组12例,SimpsonⅡ、Ⅲ级切除合并放疗组11例,Ⅱ、Ⅲ级切除无放疗组11例.各组的PFS中位数分别为72个月、20个月、24个月和13个月（P=0.001）.复发率分别为58％、92％、91％和91％.结论 间变性脑膜瘤为高复发率、高病死率的恶性肿瘤,手术切除程度和术后放疗对肿瘤的预后存在明显影响;Simpson Ⅰ级切除的肿瘤和术后放疗能明显延长PFS,但降低肿瘤复发率不明显;尽可能做到Simpson Ⅰ级切除肿瘤并术后放疗是间变性脑膜瘤的有效治疗手段.

Objective To investigate the treatment and prognosis of intracranial anaplastic meningioma. Methods From January 2008 to July of 2013, the clinical data of 51 patients with intracranial anaplastic meningioma received surgical treatment at the Cooperative Wards, Departments of Nenrosurgery, Beijing Electrical Power Hospital and Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively. Their factors related to prognosis were analyzed. Results All 51 patients received surgical treatment. The tumors were confirmed as anaplastic （malignant） meningioma by histopathology. Forty-six of them were followed up, 24 had Simpson grade I resection in the first operation, and a total of 22 had Simpson grade Ⅱ and Ⅲ resection. The postoperative complications were mainly the loss of nerve function on the location of the tumors. In the 46 patients to be followed up, a total of 96 surgeries were performed, 37 had recurrence. The recurrence rate was 80%, and 2-year recurrence rate was 52%. The progression-free survival （PFS） was 2-73 （median 24） months. In the 46 patients to be followed up, 12 patients were in a Simpson grade I resection combined radiotherapy group, 12 were in a Simpson grade I resection without radiotherapy group, 11 were in a Simpson Grade Ⅱ and m resection without radiotherapy group. The median PFS in each group were 72, 20, 24, and 13 months, respectively （ P=0. 001 ）. The recurrence rates were 58% , 92% , 91% , and 91%, respectively. Conclusions Anaplastic meningioma is a malignant tumor with high recurrence rate and high mortality. The degrees of surgical resection and postoperative radiotherapy have obvious influence on the prognosis of the tumors. The tumors with Simpson grade I resection and postoperative radiotherapy may significantly prolong PFS, but the decrease of tumor recurrence rate is not obvious. Simpson grade I resection of the tumor should be achieved as far as possible and postoperative radiotherapy is an effective treatment means for anaplastic meningioma.