Palma L, Celli P, Franco C, Cervoni L, Cantore G
Department of Ophthalmological and Neurosurgical Sciences of Siena University Medical School, Le Scotte Hospital, Siena, Italy.
Neurosurg Focus. 1997 Apr 15;2(4):e3. doi: 10.3171/foc.1997.2.4.6.
To contribute to a better understanding of the prognostic differences between atypical and malignant meningiomas as defined by the World Health Organization (WHO) and the influence of the grade of initial surgical excision on postoperative course, 42 cases of atypical and 29 of malignant meningioma were studied, along with long-term follow up. The two groups were compared with respect to long-term survival, recurrence-free survival, and median time to recurrence. The prognostic significance of the Simpson grade of surgical resection and tumor location was also considered. Survival at 5 and 10 years was recorded in 95% and 79%, respectively, of patients with atypical meningioma and in 64.3% and 34.5% of patients with malignant meningioma (p = 0.001). Recurrence-free survival and median time to recurrence were also significantly longer in patients with atypical than in those with malignant meningiomas: 11.9 versus 2 years (p = 0.001) and 5 versus 2 years (p < 0.0041), respectively. Six (26%) of the 23 recurring atypical meningiomas became malignant. Simpson Grade I resection and location in the cerebral convexity, which were closely related, were found to be associated with a significantly better clinical course in the entire series (p < 0.0016). Patients with atypical meningiomas fared better than those with malignant meningiomas after incomplete surgical excision (Simpson Grades II-III), but the difference was not statistically significant. Multivariate analysis using the Cox model indicated that radical extirpation (Simpson Grade I vs. II-III) and histological findings (atypical meningioma vs. malignant meningioma) were significantly related to prolonged survival (p < 0.0003 and p < 0.0388, respectively). In conclusion, the current study shows that for most patients with atypical meningioma the prognosis was less severe than for those with malignant meningioma, but the risk of a downhill course resulting from malignancy after incomplete resection and recurrence was not negligible (26%). In addition, the WHO classification was found to be inadequate for a minority of the atypical meningioma cases, which currently have the same unfavorable course as cases of malignant meningioma. The results also indicate that objective Simpson Grade I extirpation of convexity meningiomas can be successful despite histological findings of malignancy.
为了更好地理解世界卫生组织（WHO）定义的非典型和恶性脑膜瘤之间的预后差异，以及初次手术切除程度对术后病程的影响，我们对42例非典型脑膜瘤和29例恶性脑膜瘤进行了研究，并进行了长期随访。比较了两组的长期生存率、无复发生存率和复发中位时间。还考虑了手术切除的辛普森分级和肿瘤位置的预后意义。非典型脑膜瘤患者5年和10年生存率分别为95%和79%，恶性脑膜瘤患者分别为64.3%和34.5%（p = 0.001）。非典型脑膜瘤患者的无复发生存率和复发中位时间也显著长于恶性脑膜瘤患者：分别为11.9年和2年（p = 0.001）以及5年和2年（p < 0.0041）。23例复发的非典型脑膜瘤中有6例（26%）恶变。发现辛普森I级切除与大脑凸面位置密切相关，在整个系列中与显著更好的临床病程相关（p < 0.0016）。不完全手术切除（辛普森II - III级）后，非典型脑膜瘤患者的预后优于恶性脑膜瘤患者，但差异无统计学意义。使用Cox模型进行多因素分析表明，根治性切除（辛普森I级与II - III级）和组织学结果（非典型脑膜瘤与恶性脑膜瘤）与生存期延长显著相关（分别为p < 0.0003和p < 0.0388）。总之，本研究表明，对于大多数非典型脑膜瘤患者，预后比恶性脑膜瘤患者轻，但不完全切除和复发后恶变导致病情恶化的风险不可忽视（26%）。此外，发现WHO分类对少数非典型脑膜瘤病例不适用，这些病例目前与恶性脑膜瘤病例有相同的不良病程。结果还表明，尽管组织学检查发现为恶性，但对凸面脑膜瘤进行客观的辛普森I级切除仍可能成功。
