大型原发性颅内孤立性纤维瘤的显微手术治疗效果及预后影响因素分析

Microsurgical efficacy of large primary intracranial solitary fibrous tumor and influencing factors for prognoses

目的探讨大型原发性颅内孤立性纤维瘤(SFT)的手术治疗效果及预后影响因素。方法回顾性纳入华中科技大学同济医学院附属武汉市中心医院及同济医院神经外科自2010年1月至2022年12月采用显微手术治疗的47例大型原发性颅内SFT患者,分析患者的临床资料、手术治疗效果及随访结果,明确肿瘤全切及患者预后的影响因素。结果肿瘤位于幕上32例,幕下15例,其中累及窦旁24例。病理分级依据WHO分级分为:1级5例(10.6%),2级32例(68.1%),3级10例(21.3%)。31例(66.0%)患者实现肿瘤全切,16例(34.0%)为次全切除。7例(14.9%)患者术后出现术腔出血、远隔部位硬膜外血肿、皮下积液等手术并发症,均经二次手术或保守治疗后治愈。另有3例患者遗留肢体活动障碍,3例患者遗留视力障碍,2例术后合并癫痫发作。13例(27.7%)患者术后进行了辅助放疗。47例患者术后随访(69.1±29.6)个月,29例(61.7%)患者肿瘤复发,其中6例出现颅内及颅外转移,4例患者死亡。47例患者无进展生存时间为(57.5±25.1)个月,术后1年、3年、5年无进展生存率分别为95.7%、87.2%、59.6%。病变是否累及窦旁是影响肿瘤全切的重要因素,手术全切是大型原发性颅内SFT患者无进展生存时间的独立保护因素(HR=4.291,95%CI:1.555~11.839,P=0.005)。结论大型原发性颅内SFT患者术后复发风险较高,肿瘤全切可有效预防肿瘤复发。

Objective To investigate the microsurgical efficacy of large primary intracranial solitary fibrous tumor and influencing factors for its prognoses.Methods From January 2010 to December 2022,47 patients with large primary intracranial solitary fibrous tumor admitted to and accepted microsurgery in Department of Neurosurgery,Wuhan Central Hospital and Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,were enrolled.The clinical data,microsurgical efficacy and follow-up results of these patients were retrospectively analyzed,and influencing factors for total resection and prognoses were determined.Results Thirty-two patients had tumor within the supratentorial region and 15 in the mandibular region,including 24 with sinus involved tumor.According to 2021 WHO Classification of Tumors of the Central Nervous System,5 patients(10.6%)had grading 1,32(68.1%)grading 2,and 10(21.3%)grading 3.Total resection was achieved in 31 patients(66.0%)and subtotal resection in 16 patients(34.0%).Postoperative complications,such as intraoperative hemorrhage,distant epidural hematoma and subcutaneous effusion,occurred in 7 patients(14.9%)and they were cured after secondary hematoma removal or conservative treatment;residual limb mobility disorder occurred in 3 patients,visual impairment in 3,and postoperative seizures in 2.Adjuvant radiotherapy was performed in 13 patients(27.7%).Follow-up was performed for(69.1±29.6)months and 29 patients(61.7%)had recurrent tumors(6 with intracranial and extracranial metastases and 4 deaths).Mean progression-free survival was(57.5±25.1)months;the 1-,3-,and 5-year progression-free survival rates were 95.7%,87.2%,and 59.6%,respectively.Sinus involvement was the independent influencing factor for total tumor resection;and total resection was an independent protective factor for progression-free survival for large primary intracranial solitary fibrous tumor(HR=4.291,95%CI:1.555-11.838,P=0.005).Conclusion Patients with large primary intracranial solitary fibrous tumor have a high recurrent risk after surgery;and gross-total resection should be strived to prevent tumor recurrence.