Pisćević Ivan, Villa Alessandro, Milićević Mihailo, Ilić Rosanda, Nikitović Marina, Cavallo Luigi Maria, Grujičić Danica
Clinic of Neurosurgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy.
World Neurosurg. 2015 Jun;83(6):987-95. doi: 10.1016/j.wneu.2015.02.021. Epub 2015 Mar 11.
Atypical and anaplastic meningiomas (World Health Organization classification grade II and III) represent a small and heterogeneous subgroup of meningiomas that has a more aggressive biological nature and higher frequency of recurrence. The atypical form accounts for 4.7%-7.2%, whereas the anaplastic type accounts for 1%-2.8% of all meningiomas. The aim of this study is to evaluate the role of postoperative radiotherapy on overall survival and progression-free survival in patients operated for atypical and anaplastic meningiomas.
A retrospective analysis of the patients operated at the Clinic of Neurosurgery, Clinical Center of Serbia, Belgrade, between January 1, 1995 and December 31, 2006 was performed. In that period 88 lesions met the histologic criteria for atypical (75) and anaplastic (13) meningiomas. Postoperative radiotherapy was conducted in 63.6% of patients.
At a median follow-up of 67.4 months the overall survival was 68 months and the 5-year survival was about 54.5%. The median survival was 76 months with surgery and adjuvant radiotherapy and 40 months with surgery alone (log rank = 7.4; P = 0.006). Recurrent disease occurred in 58 patients (65.9%). Median time between first surgery and tumor recurrence in patients undergoing radiotherapy was 51 months, whereas in the nonirradiated group it was 24 months (log rank = 17.7; P < 0.001). Multivariate analysis identified as recurrence-predicting factors anaplastic histotype (hazard ratio = 2.9; P = 0.003) and postoperative radiotherapy (hazard ratio = 4.5; P < 0.001).
The addition of adjuvant radiotherapy to surgery for atypical and anaplastic meningiomas resulted in a clinically meaningful and statistically significant survival benefit.
非典型和间变性脑膜瘤（世界卫生组织分类二级和三级）是脑膜瘤中的一个小且异质性的亚组，具有更具侵袭性的生物学特性和更高的复发频率。非典型形式占所有脑膜瘤的4.7%-7.2%，而间变性类型占1%-2.8%。本研究的目的是评估术后放疗对接受非典型和间变性脑膜瘤手术患者的总生存期和无进展生存期的作用。
对1995年1月1日至2006年12月31日期间在塞尔维亚贝尔格莱德临床中心神经外科诊所接受手术的患者进行回顾性分析。在此期间，88个病变符合非典型（75个）和间变性（13个）脑膜瘤的组织学标准。63.6%的患者接受了术后放疗。
中位随访67.4个月时，总生存期为68个月，5年生存率约为54.5%。手术加辅助放疗的中位生存期为76个月，单纯手术为40个月（对数秩检验=7.4；P=0.006）。58例患者（65.9%）出现疾病复发。接受放疗患者首次手术与肿瘤复发之间的中位时间为51个月，而未接受放疗组为24个月（对数秩检验=17.7；P<0.001）。多因素分析确定间变性组织学类型（风险比=2.9；P=0.003）和术后放疗（风险比=4.5；P<0.001）为复发预测因素。
对于非典型和间变性脑膜瘤，手术加辅助放疗可带来具有临床意义且在统计学上有显著意义的生存获益。
