Department of Neurosurgery, LSU Health Shreveport, Louisiana.
J Neurosurg. 2017 Jan;126(1):201-211. doi: 10.3171/2016.1.JNS151842. Epub 2016 Apr 8.
OBJECTIVE The clinical significance of the Simpson system for grading the extent of meningioma resection and its role as a predictor of the recurrence of World Health Organization (WHO) Grade I meningiomas have been questioned in the past, echoing changes in meningioma surgery over the years. The authors reviewed their experience in resecting WHO Grade I meningiomas and assessed the association between extent of resection, as evaluated using the Simpson classification, and recurrence-free survival (RFS) of patients after meningioma surgery. METHODS Clinical and radiological information for patients with WHO Grade I meningiomas who had undergone resective surgery over the past 20 years was retrospectively reviewed. Simpson and Shinshu grading scales were used to evaluate the extent of resection. Statistical analysis was conducted using Kaplan-Meier curves and Cox proportional-hazards regression. RESULTS Four hundred fifty-eight patients were eligible for analysis. Overall tumor recurrence rates for Simpson resection Grades I, II, III, and IV were 5%, 22%, 31%, and 35%, respectively. After Cox regression analysis, Simpson Grade I (extensive resection) was revealed as a significant predictor of RFS (p = 0.003). Patients undergoing Simpson Grade I and II resections showed significant improvement in RFS compared with patients undergoing Grade III and IV resections (p = 0.005). Extent of resection had a significant effect on recurrence rates for both skull base (p = 0.047) and convexity (p = 0.012) meningiomas. Female sex and a Karnofsky Performance Scale score > 70 were also identified as independent predictors of RFS after resection of WHO Grade I meningioma. CONCLUSIONS In this patient cohort, a significant association was noted between extent of resection and rates of tumor recurrence. In the authors' experience the Simpson grading system maintains its relevance and prognostic value and can serve an important role for patient education. Even though complete tumor resection is the goal, surgery should be tailored to each patient according to the risks and surgical morbidity.
目的：辛普森系统（Simpson system）用于分级脑膜瘤切除术的程度，以及作为世界卫生组织（World Health Organization，WHO）I 级脑膜瘤复发预测因子的临床意义，过去曾受到质疑，这反映了多年来脑膜瘤手术的变化。作者回顾了他们切除 WHO I 级脑膜瘤的经验，并评估了使用辛普森分类法评估的切除程度与脑膜瘤手术后患者无复发生存（recurrence-free survival，RFS）之间的关系。
方法：回顾性分析过去 20 年接受切除术的 WHO I 级脑膜瘤患者的临床和影像学资料。使用辛普森（Simpson）和新潟（Shinshu）分级量表评估切除程度。使用 Kaplan-Meier 曲线和 Cox 比例风险回归进行统计分析。
结果：458 例患者符合分析条件。辛普森切除分级 I、II、III 和 IV 级的总体肿瘤复发率分别为 5%、22%、31%和 35%。Cox 回归分析后，辛普森分级 I（广泛切除）被揭示为 RFS 的显著预测因子（p = 0.003）。与行 III 级和 IV 级切除术的患者相比，行辛普森分级 I 和 II 级切除术的患者的 RFS 显著改善（p = 0.005）。切除程度对颅底（p = 0.047）和凸面（p = 0.012）脑膜瘤的复发率均有显著影响。女性和 Karnofsky 表现量表评分>70 也被确定为 WHO I 级脑膜瘤切除后 RFS 的独立预测因子。
结论：在本患者队列中，切除程度与肿瘤复发率之间存在显著关联。在作者的经验中，辛普森分级系统仍然具有相关性和预后价值，并可为患者教育提供重要作用。尽管完全切除肿瘤是目标，但应根据风险和手术发病率为每位患者量身定制手术。
World Neurosurg. 2016-6
J Neurol Surg B Skull Base. 2024-4-30
Biomedicines. 2025-3-7
Surg Neurol Int. 2024-12-13
Vet Comp Oncol. 2025-3
Neurosurg Rev. 2024-11-11
Cancers (Basel). 2024-6-19
Surg Neurol Int. 2024-5-10
Zotero 插件