恶性脑膜瘤术后复发的相关因素分析

Analysis of related factors of postoperative recurrence of malignant meningiomas

目的探讨影响恶性脑膜瘤（WHOⅢ级）术后复发的相关因素。方法回顾性纳入2002年1月至2015年12月西南医科大学附属医院神经外科收治的24例恶性脑膜瘤患者。对其术后的复发情况进行随访，应用单因素Kaplan—Meier生存分析和多因素Cox回归分析判断影响恶性脑膜瘤复发的独立因素。结果24例恶性脑膜瘤患者中，有17例（71％）复发。单因素Kaplan—Meier生存分析结果显示：年龄（P=0．009）、瘤周水肿程度（P=0．005）、肿瘤最大径（P=0．050）、侵袭性类型（P=0．011）和手术切除程度（P=0．002）具有判断恶性脑膜瘤术后复发的价值。但经多因素Cox回归分析后，剔除侵袭性类型（RR=0．699，95％CI：0．184～2．658，P=0．600）、瘤周水肿程度（RR=2．915，95％CI：0．881—9．648，P=0．080）和肿瘤最大径（RR=1．314，95％CI：0．250～6．921，P=0．747），仅有年龄（RR=4．379，95％CI：1．125～17．051，P=0．033）和肿瘤切除程度（RR=3．442，95％CI：1．314～9．016，P=0．012）是影响恶性脑膜瘤复发的独立危险因素，差异具有统计学意义。结论恶性脑膜瘤的肿瘤侵袭性类型、瘤周水肿程度和肿瘤最大径可能影响患者肿瘤的复发；年龄和肿瘤切除程度是影响恶性脑膜瘤复发的独立危险因素。

Objective To investigate the factors related to postoperative recurrence of malignant meningiomas （WHO grade of m ）. Methods A total of 24 pathologically confirmed cases of malignant meningiomas admitted to Neurosurgery Department of Affiliated Hospital of Southwest Medical University between January 2002 to December 2015 were enrolled into this respective study. The patients were followed up for possible recurrence and the related factors were studied by using single factor Kaplan - Meier survival analysis and multivariate Cox regression analysis. Results Seventeen （71% ） of the 24 patients with malignant meningiomas relapsed. The analysis results on recurrent malignant meningiomas showed that age （ P = 0. 009 ） , peritumoral edema （ P = 0. 005 ） , tumor size （ P = 0. 050 ） , invasive type （ P = 0.011 ） and extent of surgical resection （ P = 0. 002） had statistical significance in malignant meningioma recurrence. However, by multivariate Cox regression analysis, excluding the invasive type （RR = 0.699, 95% CI： 0. 184 -2. 658, P = 0. 600 ） , peritumoral edema （ RR = 2.915, 95 % CI： 0.881 - 9. 648, P= 0. 080 ） and tumor size （ RR = 1.314, 95% CI： 0.250-6.921, P=0.747）, only the age （RR =4.379, 95% CI： 1. 125 -17.051, P= 0. 033 ） and degree of surgical resection （RR = 3. 442, 95% CI： 1. 314 - 9. 016, P = 0. 012） had statistical significance. Conclusions The peritumoral edema degree, tumor invasive type and tumor size of malignant meningiomas may affect the patients＇ recurrence. Age and extent of resection seem to be independent factors in determining the recurrence of malignant meningiomas.