非典型脑膜瘤术后复发影响因素分析

Analysis of factors influencing postoperative recurrence of atypical meningioma

目的分析影响非典型脑膜瘤复发的影响因素。方法回顾性分析2013-01—2016-12间在郑州大学第一附属医院行手术治疗且经病理学证实的94例非典型脑膜瘤患者。通过多因素Cox回归分析方法评价影响术后复发的临床因素。结果94例患者发病年龄12~78岁,男∶女=1∶1.29。82例肿瘤全切除,12例肿瘤次全切除。所有患者术后随访11~66个月,中位时间36个月。其中行手术及辅助放疗43例,仅行手术治疗51例。其间31例肿瘤复发。1 a、3 a无进展生存率分别为87.2%、57.1%,1 a、3 a、5 a总生存率为98.2%、78.1%、73.4%。单因素分析表明年龄≥50岁、非原发性、位于颅底、脑侵犯、Ki67指数>10%及次全切除,与非典型脑膜瘤术后高复发率有关。多因素分析结果表明,年龄、脑侵犯、Ki67指数及切除程度是影响肿瘤复发的独立危险因素。结论非典型脑膜瘤具有高复发率和高病死率,年龄≥50岁、非原发性、位于颅底、脑侵犯、Ki67指数>10%及次全切除与非典型脑膜瘤术后高复发率有关,其中年龄、脑侵犯、Ki67指数及切除程度是影响肿瘤复发的独立危险因素。最大安全范围切除肿瘤是最主要的治疗措施,对于不完全切除的肿瘤和位于矢状窦旁或颅底的肿瘤推荐接受辅助放疗。

Objective To analyze factors affecting the recurrence of atypical meningioma.Methods Retrospective analysis of 94 patients with atypical meningioma who underwent surgical treatment and confirmed by pathology in the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2016.Evaluation of clinical factors affecting postoperative recurrence of atypical meningioma by multivariate Cox regression analysis.Results The average age of onset in 94 patients was 12~78 years,females predominate,the ratio of male to female is 1∶1.29.Totally 82 patients underwent total tumor resection,and 12 underwent subtotal resection.A median follow-up of 36 months(11-66months).Among them,43 cases underwent surgery and adjuvant radiotherapy,only 51 cases underwent surgery,31 cases tumor recurrence.The 1-year and 3-year progression-free survival rates were 87.2%and 57.1%,respectively.The 1-,3-,and 5-year overall survival rates were 98.2%,78.1%,and 73.4%.Univariate analysis showed that age greater than 50 years,non-primary,located in the skull base,brain invasion,Ki67 index greater than 10%and subtotal resection were associated with high recurrence rate after atypical meningioma surgery.Multivariate analysis showed that age,brain invasion,Ki67 index,and degree of resection were independent risk factors for tumor recurrence.Conclusion Atypical meningioma has high recurrence rate and high mortality,age greater than 50 years,non-primary,located in the skull base,brain invasion,Ki67 index greater than 10%and subtotal resection associated with high recurrence rate after atypical meningioma surgery.Among them,age,brain invasion,Ki67 index and degree of resection are independent risk factors for tumor recurrence.Resection of the tumor with the greatest safety margin is the most important treatment for atypical meningioma.Adjuvant radiotherapy is recommended for incompletely resected tumors and tumors located next to the sagittal sinus or skull base.