Hammouche Salah, Clark Simon, Wong Alex Hie Lin, Eldridge Paul, Farah Jibril Osman
Neurosurgery Department, The Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, L9 7LJ, Merseyside, UK,
Acta Neurochir (Wien). 2014 Aug;156(8):1475-81. doi: 10.1007/s00701-014-2156-z. Epub 2014 Jun 26.
The rarity and the inconsistent criteria for defining atypical meningioma prior to the WHO 2007 classification made its management and prognostic factors poorly understood. Only few articles have addressed the survival rates of WHO-classified atypical meningiomas. The small number or the disproportionate representation of irradiated patients was a weakness for these articles. This study evaluated whether the extent of surgery and receiving adjuvant radiotherapy after an initial operation along with other patient characteristics influenced the recurrence and survival rates of atypical meningiomas.
The clinical and surgical notes of the 79 patients with grade II atypical meningioma treated at our center over 13 years were retrospectively evaluated. The histology grading was consistent with WHO 2007 classification. The Simpson grading system was used to assess the extent of surgical resection. Kaplan Meier analysis, Cox multivariate regression analysis, and the Log-rank test were conducted using STATA® statistical package.
The average age at the time of initial operation was 58 years, and 54 % were males. The mean follow-up period was 50 months. In Cox multivariate analysis, only Simpson grading was predictive of recurrence (hazard ratio = 2.22 / 1 increase in Simpson grade. p = 0.003). Simpson grade I patients had a relapse-free survival rate of 97 and 74 % at one and five years, respectively, compared with 88 and 32 % in the subtotal resection group (Simpson grades II to IV). There was no statistically significant correlation between recurrence and subjecting patients to postoperative radiotherapy. Apart from Simpson grade I patients, there was a general trend for worse outcome in irradiated patients.
The most important prognostic factor in determining recurrence was Simpson grading. There was no statistically significant impact of adjuvant radiotherapy on the recurrence of atypical meningiomas. Meta-analysis for the existing literature is needed.
在2007年世界卫生组织（WHO）分类之前，非典型脑膜瘤较为罕见，且定义标准不一致，这使得其治疗方法和预后因素难以理解。仅有少数文章探讨了WHO分类的非典型脑膜瘤的生存率。这些文章存在的一个缺陷是纳入的接受放疗患者数量少或代表性不均衡。本研究评估了手术范围、初次手术后接受辅助放疗以及其他患者特征是否会影响非典型脑膜瘤的复发率和生存率。
回顾性评估了在我们中心13年间接受治疗的79例II级非典型脑膜瘤患者的临床和手术记录。组织学分级符合WHO 2007年分类标准。采用辛普森分级系统评估手术切除范围。使用STATA®统计软件包进行Kaplan Meier分析、Cox多因素回归分析和对数秩检验。
初次手术时的平均年龄为58岁，男性占54%。平均随访期为50个月。在Cox多因素分析中，只有辛普森分级可预测复发（风险比=2.22，辛普森分级每增加1级，p = 0.003）。辛普森I级患者1年和5年的无复发生存率分别为97%和74%，而次全切除组（辛普森II至IV级）分别为88%和32%。复发与患者接受术后放疗之间无统计学显著相关性。除辛普森I级患者外，接受放疗的患者总体预后有变差趋势。
决定复发的最重要预后因素是辛普森分级。辅助放疗对非典型脑膜瘤的复发无统计学显著影响。需要对现有文献进行荟萃分析。
