Li Da, Hao Shu-Yu, Wang Liang, Tang Jie, Xiao Xin-Ru, Jia Gui-Jun, Wu Zhen, Zhang Li-Wei, Zhang Jun-Ting
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6,, Chongwen District, Beijing, 100050, People's Republic of China.
Neurosurg Rev. 2015 Jan;38(1):71-86; discussion 86-7. doi: 10.1007/s10143-014-0575-1. Epub 2014 Oct 16.
This study seeks to elucidate the prognostic predictors and outcomes of recurrent/progressive petroclival meningiomas (PCMs). We reviewed our cohort of 39 recurrent/progressive PCMs (27 females, 69.2%) and analyzed the results from the literature. Twenty-three patients underwent reoperations, 2 received radiotherapy alone, and 14 declined any treatment. During a follow-up of 70.4 months, 7 patients experienced a 2nd recurrence/progression (R/P) and 18 patients died. In the 23 patients, gross total resection (GTR), subtotal resection (STR), and partial resection (PR) were achieved in 8, 8, and 7 patients, respectively. The percentage of the 2nd R/P-free survival of GTR, STR, and PR was 88%, 67%, and 40%, respectively. The overall survival following the 1st R/P of GTR, STR, and PR was 88%, 63%, and 33%, respectively. Patients rejecting treatment suffered from significantly poor overall survival (7%; p = 0.001) and short survival duration (42.0 months; p = 0.016) compared with that of the patients receiving treatment (67% and 86.9 months). The GTR was the only independent favorable predictor. In the 21 included studies with 98 recurrent/progressive PCM patients, 17 patients presented with a 2nd R/P and 10 died of a 2nd R/P; patients undergoing observation had a significantly poor tumor regrowth control rate compared with patients undergoing surgery (p = 0.004) or radiotherapy alone (p < 0.001). Proactive treatment should be performed for patients with recurrent/progressive PCMs. Observation can lead to relentless outcome. GTR as a preferential therapeutic strategy should be pursued as far as possible on the condition of minimal functional impairment.
本研究旨在阐明复发性/进展性岩斜脑膜瘤（PCM）的预后预测因素及预后情况。我们回顾了39例复发性/进展性PCM患者（27例女性，占69.2%）的队列，并分析了文献结果。23例患者接受了再次手术，2例仅接受了放疗，14例拒绝任何治疗。在70.4个月的随访期间，7例患者出现第二次复发/进展（R/P），18例患者死亡。在23例接受再次手术的患者中，分别有8例、8例和7例实现了全切除（GTR）、次全切除（STR）和部分切除（PR）。GTR、STR和PR患者的第二次无R/P生存率分别为88%、67%和40%。GTR、STR和PR患者首次R/P后的总生存率分别为88%、63%和33%。与接受治疗的患者（67%和86.9个月）相比，拒绝治疗的患者总生存率显著较差（7%；p = 0.001）且生存时间较短（42.0个月；p = 0.016）。GTR是唯一独立的有利预测因素。在纳入的21项研究中的98例复发性/进展性PCM患者中，17例出现第二次R/P，10例死于第二次R/P；与接受手术（p = 0.004）或单纯放疗（p < 0.001）的患者相比，接受观察的患者肿瘤再生长控制率显著较差。对于复发性/进展性PCM患者应采取积极治疗。观察可能导致不良后果。在功能损害最小的情况下，应尽可能采用GTR作为优先治疗策略。
