Yamasaki F, Yoshioka H, Hama S, Sugiyama K, Arita K, Kurisu K
Department of Neurosurgery, Hiroshima University School of Medicine, Japan.
Cancer. 2000 Sep 1;89(5):1102-10. doi: 10.1002/1097-0142(20000901)89:5<1102::aid-cncr20>3.0.co;2-l.
Macroscopic total resection with removal of involved dura and bone does not always prevent the recurrence of meningioma of histologically benign subtype. Many causative factors have been investigated, although the mechanism of recurrence remains unclear. Vascular endothelial growth factor (VEGF) is a key factor in meningiomas neovascularization, and the authors investigated whether VEGF expression can predict the recurrence of histologically benign meningiomas after macroscopic total resection.
Fifty-four patients with supratentorial convexity meningiomas were investigated at least 3 years after surgery or until tumor recurrence to clarify risk factors for recurrence. Patients were restricted to Simpson Grade 1 resection only, and the authors excluded multiple meningiomas, neurofibromatosis, and atypical and anaplastic meningiomas. Correlation between recurrence and the following factors were statistically analyzed: age, gender, tumor volume, tumor shape, bone change, brain edema, vascular supply, histologic subtype, MIB-1 labeling index (LI), and VEGF expression.
Of the 54 patients with meningioma, 34 were positive (24: +1; 10: +2) for VEGF, and 20 were negative. Six (11.1%) meningiomas recurred during the follow-up period. Multivariate analysis revealed that high levels of expression of VEGF constituted the most useful predictor of recurrence (P = 0.005), followed by high MIB-1 LI (P = 0.039). The other factors were not significant. The tumor recurrence, when it occurred, was within the brain and not durally based.
The current results suggest that high levels of VEGF expression are significantly related to the recurrence of meningioma. VEGF secretion from microscopic residue remaining after surgery may induce neovascularization, which promotes the recurrence of meningioma.
切除受累硬脑膜和骨的宏观全切除并不总能预防组织学上为良性亚型的脑膜瘤复发。尽管复发机制仍不清楚，但已对许多致病因素进行了研究。血管内皮生长因子（VEGF）是脑膜瘤新生血管形成的关键因素，作者研究了VEGF表达是否能预测宏观全切除后组织学上为良性的脑膜瘤的复发。
对54例幕上凸面脑膜瘤患者在术后至少3年或直至肿瘤复发进行调查，以明确复发的危险因素。患者仅限于辛普森1级切除，作者排除了多发脑膜瘤、神经纤维瘤病以及非典型和间变性脑膜瘤。对复发与以下因素之间的相关性进行了统计分析：年龄、性别、肿瘤体积、肿瘤形状、骨质改变、脑水肿、血管供应、组织学亚型、MIB-1标记指数（LI）和VEGF表达。
54例脑膜瘤患者中，34例VEGF阳性（24例：+1；10例：+2），20例阴性。随访期间6例（11.1%）脑膜瘤复发。多因素分析显示，VEGF的高表达是复发的最有用预测指标（P = 0.005），其次是高MIB-1 LI（P = 0.039）。其他因素无统计学意义。肿瘤复发时发生在脑内而非硬脑膜。
目前的结果表明，VEGF的高表达与脑膜瘤的复发显著相关。手术后残留的微小病灶分泌的VEGF可能诱导新生血管形成，从而促进脑膜瘤的复发。
