Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata-City, Japan.
J Neurosurg. 2011 May;114(5):1224-31. doi: 10.3171/2010.11.JNS101041. Epub 2011 Jan 7.
The authors retrospectively analyzed various clinicopathological factors to determine which are related to regrowth during a long-term follow-up period in patients who underwent incomplete vestibular schwannoma (VS) resection.
This study involved 74 patients (25 men and 49 women) in whom a VS was treated surgically via the lateral suboccipital approach, and who had postoperative follow-up periods exceeding 5 years. The mean follow-up was 104.1 months (range 60-241 months), and the mean patient age at surgery was 48.1 years (range 19-75 years). The tumors ranged in size from 0 mm (localized within the internal auditory canal) to 56 mm (28.3 ± 12.2 mm [mean ± SD]).
Gross-total resection (GTR) was performed in 41 (55%) of the 74 patients; subtotal resection ([STR]; 90-99%) in 25 (34%); and partial resection ([PR]; < 90%) in 8 (11%). Regrowth rates in the GTR, STR, and PR groups were 2.4% (1 of 41 cases), 52% (13 of 25), and 62.5% (5 of 8), respectively, and the times to regrowth ranged from 6 to 76 months (median 31.9 months). The regrowth-free survival curves differed significantly between the complete (GTR) and incomplete (STR and PR) resection groups. Eighteen (54.5%) of the 33 patients who underwent incomplete resection showed evidence of regrowth during follow-up. Univariate and multivariate analyses of various factors revealed that both the thickness of the residual tumor, based on MR imaging after surgery, and the MIB-1 index were positively related to residual tumor regrowth. The receiver operating characteristic curves, plotted for both the thickness of the residual tumor and the MIB-1 index, identified the optimal cutoff points for these values as 7.4 mm (sensitivity 83.3%, specificity 86.7%) and 1.6 (sensitivity 83.3%, specificity 66.7%), respectively.
Greater residual tumor thickness, based on MR imaging after the initial surgery, and a higher MIB-1 index are both important factors related to postoperative tumor regrowth in patients who have undergone incomplete VS resection. These patients require frequent neuroimaging investigation during follow-up to assure early detection of tumor regrowth.
作者回顾性分析了各种临床病理因素,以确定在接受不完全前庭神经鞘瘤(VS)切除的患者中,哪些因素与长期随访期间的肿瘤复发有关。
本研究纳入了 74 名(25 名男性和 49 名女性)接受经外侧枕下入路手术治疗的 VS 患者,这些患者的术后随访时间超过 5 年。平均随访时间为 104.1 个月(范围 60-241 个月),手术时患者的平均年龄为 48.1 岁(范围 19-75 岁)。肿瘤大小从 0 毫米(局限于内听道内)至 56 毫米(28.3±12.2 毫米[均值±标准差])不等。
41 名(55%)患者行全切除(GTR);25 名(34%)患者行次全切除(STR;90%-99%);8 名(11%)患者行部分切除(PR;<90%)。GTR、STR 和 PR 组的肿瘤复发率分别为 2.4%(41 例中的 1 例)、52%(25 例中的 13 例)和 62.5%(8 例中的 5 例),肿瘤复发时间为 6-76 个月(中位数 31.9 个月)。完全切除(GTR)和不完全切除(STR 和 PR)组的肿瘤无复发生存曲线差异有统计学意义。33 名接受不完全切除的患者中有 18 名(54.5%)在随访期间出现肿瘤复发。对各种因素进行单因素和多因素分析显示,术后 MRI 上的残余肿瘤厚度和 MIB-1 指数均与残余肿瘤复发呈正相关。残余肿瘤厚度和 MIB-1 指数的受试者工作特征曲线分别确定了这些值的最佳截断点为 7.4 毫米(灵敏度 83.3%,特异性 86.7%)和 1.6(灵敏度 83.3%,特异性 66.7%)。
术后初始 MRI 上的残余肿瘤厚度较大,以及 MIB-1 指数较高,均是接受不完全 VS 切除患者术后肿瘤复发的重要因素。这些患者需要在随访期间频繁进行神经影像学检查,以确保早期发现肿瘤复发。