Faculty of Medicine, University of Oslo, Oslo, Norway.
J Neurosurg. 2012 Dec;117(6):999-1006. doi: 10.3171/2012.9.JNS12294. Epub 2012 Oct 12.
Recently the relevance of Simpson resection grade as a prognostic factor for recurrence of WHO Grade I meningiomas was challenged, contradicting many previous scientific reports and traditional neurosurgical teaching. The objective of this study was to determine whether the predictive value of Simpson resection grade is outdated or remains valid with respect to meningioma recurrence and overall survival.
All patients at least 16 years old who underwent primary craniotomies for convexity meningiomas at Oslo University-affiliated hospitals (Rikshospitalet and Ullevål University Hospitals) in the period between January 1, 1990, and January 27, 2011, were included. Overall survival and retreatment-free survival rates were correlated with patient- and surgery-specific factors.
Three hundred ninety-one consecutive patients were included in the study. The median patient age was 60.1 years (range 19-92 years). The female-to-male ratio was 2.1:1. The WHO grades were Grade I in 353 (90.3%), Grade II in 22 (5.6%), and Grade III in 16 (4.1%). The follow-up rate was 100%. Median follow-up time was 7.1 years (range 0.0-20.9 years) and total observation time was 3147 patient-years. The 1-, 5-, and 10-year overall survival rates were 96%, 89%, and 78%, respectively. Age, sex, WHO grade, and Simpson grade were significantly associated with overall survival. The 1-, 5-, and 10-year retreatment-free survival rates were 99%, 94%, and 90%, respectively. Simpson resection grade and WHO grade were significantly associated with retreatment-free survival. The hazard ratios for retreatment after combined Simpson resection Grades II+III and IV+V were 4.9- and 13.2-times higher than after Simpson Grade I resection, respectively.
Simpson Grade I resection should continue to be the goal for convexity meningiomas.
最近，Simpson 切除分级作为世界卫生组织（WHO）I 级脑膜瘤复发的预后因素的相关性受到了质疑，这与许多先前的科学报告和传统的神经外科学教学相矛盾。本研究的目的是确定 Simpson 切除分级的预测价值是否已经过时，或者对于脑膜瘤复发和总生存仍然有效。
纳入了 1990 年 1 月 1 日至 2011 年 1 月 27 日期间在奥斯陆大学附属医院（Rikshospitalet 和 Ullevål 大学医院）接受初次开颅手术治疗凸面脑膜瘤的至少 16 岁以上的所有患者。将总生存和无再治疗生存率与患者和手术特异性因素相关联。
本研究共纳入 391 例连续患者。患者中位年龄为 60.1 岁（范围 19-92 岁）。女性与男性的比例为 2.1:1。WHO 分级为 I 级 353 例（90.3%）、II 级 22 例（5.6%）和 III 级 16 例（4.1%）。随访率为 100%。中位随访时间为 7.1 年（范围 0.0-20.9 年），总观察时间为 3147 患者-年。1、5 和 10 年总生存率分别为 96%、89%和 78%。年龄、性别、WHO 分级和 Simpson 分级与总生存显著相关。1、5 和 10 年无再治疗生存率分别为 99%、94%和 90%。Simpson 切除分级和 WHO 分级与无再治疗生存显著相关。Simpson 切除分级为 II+III 和 IV+V 的患者的再治疗风险比分别为 Simpson 切除分级 I 患者的 4.9 倍和 13.2 倍。
Simpson 分级 I 切除应继续作为凸面脑膜瘤的目标。
