非典型脑膜瘤的临床特征及术后复发影响因素分析

Clinical Characteristics of Patients with Atypical Meningioma and andlnfluencing Factors of Postoperative Recurrence

目的探讨非典型脑膜瘤(AM)患者的临床特征及术后复发的影响因素。方法对2008年5月-2014年5月我院收治的48例AM患者的临床资料进行回顾性分析。结果本组AM患者发病大多>50岁,且肿瘤部位主要位于大脑凸面,临床症状主要以头痛为首发表现,术前Simpson分级中Ⅰ~Ⅱ级较多见,免疫组化检查Ki-67指数5%~10%最常见。本组术后复发20例(41.67%),中位无复发生存期为4.6个月,中位生存期为12.96个月。复发者Simpson分级(Ⅲ~Ⅴ级)、Ki-67指数(30%)、AM形状(蘑菇形)及瘤周水肿程度(重度)比例高于无复发者(P<0.05)。结论 AM具有术前诊断困难,高复发率及预后不良等临床特点,Simpson分级、Ki-67指数、AM形状及瘤周水肿程度为影响AM术后复发的独立危险因素。

Objective To investigate the clinical characteristics of patients with atypical meningioma （AM） and the influ- encing factors of postoperative recurrence. Methods The clinical data of 48 patients with AM hospitalized between May 2008 and May 2014 in our hospital was retrospectively analyzed. Results AM patients in this group were mostly over 50 years old, and tumors were mainly located in the convex surface of the brain. Headache usually occurred as the first symptom. Grade I to II was more common in Simpson grading before operation. Indexes 5% to10% were most common in Ki-67 immunohistochemistry. There were 20 cases （41.67%） of recurrence of AM among the 48 patients with AM. The median RFS was 4.6 months and the median OS was 12.96 months. Simpson grade （ Ⅲ~Ⅴ ） ,Ki-67 index （30%） ,AM shape （mushroom type） and peritumoral edema de- gree （severe） were prevalent in patients with recurrence of AM（ P〈0.05 ）. Conclusion AM is difficult to diagnose, and patients have a high rate of recurrence and poor prognosis. Simpson classification, Ki-67 index, AM shape and peritumoral edema are independent risk factors of AM recurrence.