颅-眶沟通脑膜瘤的临床特征及预后分析

Correlation of the clinical characteristics and prognosis of cranio-orbital meningiomas

目的分析颅-眶沟通脑膜瘤的临床特征及相关的预后因素。设计回顾性病例系列。研究对象经手术或活检病理证实的颅-眶沟通脑膜瘤56例(男27例,女29例)。方法回顾分析患者的临床、影像与病理特征,以及肿瘤进展及出现进展的时间。通过Logistic回归分析肿瘤进展与各观察指标的相关性。主要指标临床表现;MRI特征(包括T1WI及T2WI信号改变、强化程度及强化均匀度、侵犯范围);CT骨窗显示邻近骨质改变情况;治疗方案;病理组织学分级;Ki-67指数;肿瘤进展及进展时间。结果存在眼球突出35例(62.5%),视力下降23例(41.1%)。最常见的受侵部位为眶尖(82.1%,46/56)。89.3%(50/56)的病例在MRI-T1WI表现为等信号;80.4%(45/56)在T2WI表现为稍高信号,增强扫描所有病例均呈明显强化(100%,56/56),16.1%(9/56)的病例表现为不均匀强化。CT骨窗显示骨质增生与吸收破坏同时存在。治疗方法以不同程度的手术切除为主(98.2%,55/56),11例(19.6%)行术后辅助放疗。病理组织学分级WHO-I级42例(75%),II至III级14例(25%)。38例行Ki-67检测,<5%32例(84.2%),≥5%6例(15.8%)。随访时间内出现肿瘤进展22例(39.3%),中位进展时间19个月(9,52)。Logistic回归分析显示手术方式、肿物于MRI强化的均匀度、是否侵犯颅内脑实质、病理学分级、Ki-67指数是预测肿瘤进展有意义的指标。结论眶尖受累是颅-眶沟通脑膜瘤最常见特征。肿瘤完整切除、MRI显示肿瘤强化均匀、未侵犯颅内脑实质、WHO-I级、Ki-67指数<5%提示有较好的预后。

Objective To analyze the clinical characteristics and associated projnostic factors of cranio-orbital meningiomas.Design Retrospective study.Participants Fifty-six patients with 27 male and 29 female were recruited who were diagnosed to be cranio-orbital meningiomas by surgery or biopsy.Methods The clinical characteristics,imaging features,involvement lesions,histopathological grading,Ki-67 values,and treatment schemes of all the cases were reviewed retrospectively.The information of tumor progression(TP)and time to tumor progression was also obtained.The correlation of those variables and TP was analyzed by Logistic multivariate analysis.Main Outcome Measures clinical manifestation;MRI features(including T1WI and T2WI signal changes,enhancement degree,enhancement uniformity,and invasion range);the change of adjacent bone showed by CT bone window;treatment plan;histopathological grading;Ki-67 index;tumor progression and progression time.Results 35 cases(62.5%)had exophthalmos and 23 cases(41.1%)had decreased vision.The most involvement lesion of cranio-orbital meningioma was orbital apex(82.1%,46/56).89.3%of cases showed iso-intensity on T1WI(50/56),and 80.4%of cases with slight hyper-intensity on T2WI(45/56),all the tumors(100%)showed obvious enhancement,and 16.1%of cases(9/56)showed heterogeneous enhancement after contrast media injection.Surgery is the most common treatment(98.2%,55/56),with 11 cases(19.6%)performed adjuvant radiotherapy after operation.42 cases had histopathogical grading WHO-I(75%),and 14 cases with WHO-II or III(25%).Ki-67 index was obtained in 38 cases with 6 cases showing the values of≥5%(15.8%).Logistic regression analysis showed that the variables including operation method,enhancement pattern on MRI,brain involvement,WHO grading and Ki-67 value were correlated with TP significantly.Conclusion Orbital apex involvement is the most common feature of cranio-orbital meningiomas.Total tumor resection,homogeneous enhancement on MRI,no brain involvement,grading WHO-I and Ki-67<5%were associated with better tumor prognosis significantly.