Aghi Manish K, Carter Bob S, Cosgrove Garth R, Ojemann Robert G, Amin-Hanjani Sepideh, Martuza Robert L, Curry William T, Barker Fred G
Department of Neurosurgery, University of California San Francisco, San Francisco, CA 94143-0112, USA.
Neurosurgery. 2009 Jan;64(1):56-60; discussion 60. doi: 10.1227/01.NEU.0000330399.55586.63.
Atypical meningioma (AM) patients often undergo gross total resection (GTR) at the time of presentation, but subsequent prognosis and optimal management remain unclear. We sought to define the long-term recurrence rate of AMs after GTR, along with factors predicting recurrence, including postoperative radiation.
We performed a retrospective review of 108 AMs after GTR at our institution from 1993 to 2004. Recurrence risk factors were analyzed using multivariate Cox regression.
There were 600 patient-years of imaging follow-up on 48 men and 60 women. Of 108 tumors, 30 (28%) recurred 3 to 144 months after GTR (mean, 36 months). Actuarial tumor recurrence rates were 7% (1 year), 41% (5 years), and 48% (10 years). Of 108 patients, 8 received postoperative radiation without recurrence (P = 0.1). Multivariate analysis including age, sex, postoperative radiation, tumor location, MIB-1 labeling index, and 6 atypical-defining histological features identified recurrence-predicting factors: older age (hazard ratio, 1.6/decade; P = 0.01), sheeting (hazard ratio, 2.2; P = 0.025), and prominent nucleoli (hazard ratio, 2.1; P = 0.034). Recursive partitioning identified a subset, men with mitoses and prominent nucleoli, with 70% recurrence (n = 14). All patients with recurrences received radiation, and 22 of 30 patients underwent craniotomies (average, 2.7 craniotomies per patient with recurrence; range, 1-7 craniotomies). Only 1 of 22 re-resected meningiomas underwent malignant transformation. Of 30 patients with recurrence, 10 experienced tumor-induced mortality an average of 7 years after recurrence (range, 1-14 years).
After GTR without postoperative radiation, AMs have a high recurrence rate. Most recurrences occurred within 5 years after resection. Recurrences caused numerous reoperations per patient and shortened survival. Our finding suggesting lower recurrence rates in patients undergoing immediate postoperative radiation should be investigated in larger, prospective series.
非典型脑膜瘤（AM）患者通常在初诊时接受全切除（GTR），但其后续预后及最佳治疗方案仍不明确。我们试图确定GTR术后AM的长期复发率，以及预测复发的因素，包括术后放疗。
我们对1993年至2004年在我院接受GTR治疗的108例AM患者进行了回顾性研究。使用多变量Cox回归分析复发危险因素。
对48例男性和60例女性患者进行了600患者年的影像学随访。108例肿瘤中，30例（28%）在GTR术后3至144个月复发（平均36个月）。精算肿瘤复发率为7%（1年）、41%（5年）和48%（10年）。108例患者中，8例接受术后放疗后未复发（P = 0.1）。多变量分析包括年龄、性别、术后放疗、肿瘤位置、MIB-1标记指数和6种非典型定义的组织学特征，确定了复发预测因素：年龄较大（风险比，1.6/十年；P = 0.01）、片状结构（风险比，2.2；P = 0.025）和明显核仁（风险比，2.1；P = 0.034）。递归划分确定了一个亚组，即有核分裂和明显核仁的男性，复发率为70%（n = 14）。所有复发患者均接受了放疗，30例患者中有22例接受了开颅手术（平均每位复发患者2.7次开颅手术；范围，1 - 7次开颅手术）。22例再次切除的脑膜瘤中只有1例发生恶变。30例复发患者中，10例在复发后平均7年（范围，1 - 14年）出现肿瘤导致的死亡。
在未进行术后放疗的GTR术后，AM复发率较高。大多数复发发生在切除后5年内。复发导致每位患者多次再次手术并缩短生存期。我们发现提示术后立即放疗的患者复发率较低，这一发现应在更大规模的前瞻性研究中进行调查。
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