非典型性脑膜瘤复发率及其影响因素的Meta分析

Recurrence Rate and Risk Factors of Atypical Meningioma: a Meta-analysis

目的 系统评价非典型性脑膜瘤患者术后复发的总体情况。方法 计算机检索中国知网、万方数据库、中国生物医学文献数据库、维普数据库、PubMed、Embase、Web of Science和Cochrane Library数据库,搜集关于非典型性脑膜瘤肿瘤复发的相关文献,检索时限均为建库至2021年7月。由两位研究者独立筛选文献,提取数据并评估纳入研究的偏倚风险后,采用R 5.0进行Meta分析。结果 共纳入29个研究,包括3122例患者。Meta分析结果显示,非典型性脑膜瘤患者术后肿瘤总体复发率为38%。亚组分析结果显示,≥60岁患者肿瘤复发率为51%,<60岁患者肿瘤复发率为40%,差异无统计学意义。男性和女性患者肿瘤复发率分别为42%和44%,差异无统计学意义。矢状窦旁脑膜瘤复发率高达52%,患者出现脑组织浸润后肿瘤复发率为47%,Ki-67>8%的患者复发率为63%,有丝分裂数≥6/10高倍视野的患者肿瘤复发率为53%,存在组织坏死的患者肿瘤复发率为69%。肿瘤次全切的复发率高达58%,接受放疗较未接受放疗的患者肿瘤复发率高,分别为38%、29%(P=0.007)。结论 非典型性脑膜瘤患者术后肿瘤复发率较高,需予以一定的重视并采取相应的干预措施,以提高患者无瘤生存率。

Objective To systematically review the overall status of postoperative recurrence in patients with atypical meningiomas.Methods China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, VIP Database, PubMed, Embase, Web of Science, and Cochrane Library were searched for collection of the relevant literature on the recurrence of atypical meningioma from database establishment to July 2021.Two investigators independently screened the literature, extracted data, and assessed the risk of bias of the included studies, and then performed a meta-analysis by using R 5.0.Results A total of 29 studies involving 3122 patients were included in this study.The meta-analysis showed that the overall postoperative recurrence rate of atypical meningioma was 38%.The subgroup analysis showed that the tumor recurrence rate of patients ≥60 years old and<60 years old was 51% and 40%,respectively, with no significant difference.The tumor recurrence rates in male and female patients were 42% and 44%,respectively, which showed no significant difference.The recurrence rates of the patients with parasagittal meningiomas, brain tissue infiltration, Ki-67>8%,mitotic count ≥6/10 high-power fields, and tissue necrosis were 52%,47%,63%,53%,and 69%,respectively.The recurrence rate after subtotal tumor resection was as high as 58%,and the patients who received radiotherapy had higher tumor recurrence rate than that those who did not receive radiotherapy(38% vs.29%,P=0.007).Conclusions The current evidence demonstrates that atypical meningioma has a high recurrence rate after surgery.It is essential to pay more attention and take corresponding measures to improve the tumor-free survival rate of the patients.