非典型脑膜瘤的生存分析

Survival analysis of atypical meningiomas

目的探讨非典型脑膜瘤患者的预后因素。方法收集31例手术并经病理诊断的非典型脑膜瘤患者的临床及随访资料。应用Kaplan-Meier法和Cox回归模型对其性别、年龄、肿瘤部位、Karnofsky功能状态评分(KPS评分)、肿瘤切除程度,手术后放疗等临床特征进行单因素和多因素生存分析。结果 31例患者中,男15例,女16例,平均存活时间为123个月,3年生存率为89%,5年生存率84%,8年生存率为72%。29例大体全切的患者中平均复发时间为个71个月,中位复发时间为52个月,3年复发率30%,5年复发率为51%,8年复发率为62%。单因素分析发现手术切除程度(P=0.03)对非典型脑膜瘤的生存时间有影响,手术次数(P=0.01)和手术切除程度(P=0.001)对复发时间有影响。Cox多因素预后分析发手术切除程度(P=0.006)对生存时间有影响,肿瘤位置、手术次数、手术切除程度、术前KPS分级影响复发时间。结论手术全切是延长非典型脑膜瘤患者生存期的重要手段。

Objective The outcomes and prognoostic factors of atypical meningiomas were discussed. Methods The clinical and follow-up data were analyzed retrospectively in 31 patients with histologically proven atypical meningiomas who received the operation. Univariate and multivariate analysis were performed between gender, age, tumor location, Karnofsky Performance Status （KPS）, extent of resection, adjuvant radiology and survival time using Kaplan-Meier survival analysis and Cox proportional hazards models. Results Of 31 patients, 15 were male and 16 were female with a mean survival of 123 months. The 3-year, 5-year and 8-year overall survival （OS） were 89%, 84% and 72%, respectively. Of 29 patients with surgical gross-total resection, the mean survival time was 71 months with a median time of 52 months. 3-year, 5-year and 8-year recurrence-free survival （RFS） were 30%, 51% and 62%, respectively. Univariate analysis showed the surgical extent of resection （P =0. 03） was significant associated with OS, and the resection extent and multiple surgeries was related with RFS. Surgical extent of resection had significant effect on OS and tumor location, multiple surgeries, surgical extent of resection, and pre-operative Karnofsky performance status scale were related with RFS analyzed by Cox proportional hazards models. Conclusion Surgical gross-total resection is the key means to prolong survival time of patients with atypical meningiomas.