非典型脑膜瘤的局部控制和总生存率：一项回顾性研究。
Local control and overall survival in atypical meningioma: a retrospective study.
作者信息
Goyal L K, Suh J H, Mohan D S, Prayson R A, Lee J, Barnett G H
机构信息
Department of Radiation Oncology, The Cleveland Clinic Foundation, OH 44195, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2000 Jan 1;46(1):57-61. doi: 10.1016/s0360-3016(99)00349-1.
PURPOSE
To evaluate local control and overall survival after primary surgery for patients with atypical meningiomas.
METHODS AND MATERIALS
From the Department of Pathology database, we identified 491 cases of meningioma treated at the Cleveland Clinic Foundation from 1979 through 1995. Thirty-three were diagnosed with atypical meningioma. Eleven of the excluded patients had incomplete records, were lost to follow-up, or received treatment elsewhere. Of the 22 evaluable patients, 15 underwent gross total resection (GTR), 4 had a subtotal resection (STR), and 3 had a resection of unknown extent. Eight patients received radiation therapy (2 after initial resection and 6 after at least one recurrence). The median radiation dose was 5,400 cGy (range 3,500-5,940). The median age at presentation was 55.5 years, the male:female ratio was 14:8, and 19/22 patients had a Karnofsky performance score (KPS) > or =80. The independent variables analyzed for overall survival and local control were gender, KPS (> or =80 vs. < 80), extent of surgery (GTR vs. STR or unknown extent of surgery), and postoperative radiation therapy.
RESULTS
Median survival was 10.6 years, with a median follow-up of 5.5 years (range 1.5-14.8). Eight of the 22 patients had local recurrence, including 2/15 with GTR, 3/4 with STR, and all 3 patients who underwent resection of unknown extent. At 10 years, patients with GTR had a higher local control rate than those who had either a STR or a resection of unknown extent (87% vs. 17%; p = 0.02). The 5- and 10-year overall survival rates for the entire group were 91% and 76%, respectively. Patients who had GTR had 5- and 10-year overall survival of 87% and 87%, respectively. Patients with STR or resection of unknown extent had 5- and 10-year overall survival rates of 100% and 75%, respectively.
CONCLUSION
In patients with atypical meningiomas, gross total resection is associated with a lower recurrence rate than in subtotal resection.
目的
评估非典型脑膜瘤患者接受初次手术后的局部控制情况和总生存率。
方法和材料
从病理科数据库中，我们识别出1979年至1995年在克利夫兰诊所基金会接受治疗的491例脑膜瘤病例。其中33例被诊断为非典型脑膜瘤。11例被排除的患者记录不完整、失访或在其他地方接受治疗。在22例可评估的患者中，15例行全切除（GTR），4例行次全切除（STR），3例行切除范围不明的手术。8例患者接受了放射治疗（2例在初次切除后，6例在至少一次复发后）。中位放射剂量为5400 cGy（范围3500 - 5940）。就诊时的中位年龄为55.5岁，男女比例为14:8，22例患者中有19例卡氏评分（KPS）≥80。分析总生存率和局部控制情况的独立变量为性别、KPS（≥80 vs. <80）、手术范围（GTR vs. STR或手术范围不明）以及术后放射治疗。
结果
中位生存期为10.6年，中位随访时间为5.5年（范围1.5 - 14.8）。22例患者中有8例出现局部复发，包括15例GTR患者中的2例，4例STR患者中的3例，以及所有3例手术范围不明的患者。10年时，GTR患者的局部控制率高于STR或手术范围不明的患者（87% vs. 17%；p = 0.02）。整个组的5年和10年总生存率分别为91%和76%。GTR患者的5年和10年总生存率分别为87%和87%。STR或手术范围不明的患者的5年和10年总生存率分别为100%和75%。
结论
在非典型脑膜瘤患者中，全切除与次全切除相比复发率更低。
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