Hori Yusuke S, Aoi Mizuho, Oda Kazunori, Fukuhara Toru
Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan.
Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan.
World Neurosurg. 2017 Sep;105:714-719. doi: 10.1016/j.wneu.2017.06.043. Epub 2017 Jun 20.
Various risk factors for recurrence of chronic subdural hematomas (CSDHs) have been reported, including alcohol addiction and diabetes mellitus. However, the significance of malignant tumors with respect to CSDH recurrence remains unclear.
We retrospectively evaluated 281 patients with a first-time CSDH from 2006 to 2016. The difference in the recurrence rate within 100 days postoperatively was compared between patients with a past or present extracranial malignant tumor and those with neither a past nor present extracranial malignant tumor at presentation. Patients in the former group were further divided into 2 subgroups: those with present tumors and those with past tumors. Statistical significance was defined as P < 0.05.
A significantly greater repeated recurrence rate (>2 recurrences) was observed in patients with than without a past or present malignant tumor (8.5% vs. 1.7%, respectively; P = 0.01); no significant difference in the first recurrence rate was observed (19.1% vs. 16.2%, respectively; P = 0.63). Furthermore, patients with a present malignant tumor showed a marginally increased repeated recurrence rate than did patients with a past malignant tumor (20.0% vs. 3.1%, respectively; P = 0.053). In the multivariate analysis, a monolayer hematoma was the only risk factor for first recurrence (odds ratio, 3.16; P = 0.003), while a present malignant tumor was the only significant risk factor for repeated recurrences (odds ratio, 16.49; P = 0.002).
The presence of a malignant tumor can be a novel predictive factor for repeated CSDH recurrences. Patients with malignant tumors should be carefully followed, and treatment options such as subcutaneous reservoir placement may be considered to prevent further recurrences.
已有多种慢性硬膜下血肿（CSDH）复发的风险因素被报道，包括酒精成瘾和糖尿病。然而，恶性肿瘤与CSDH复发之间的关系仍不明确。
我们回顾性评估了2006年至2016年期间首次发生CSDH的281例患者。比较了既往或当前患有颅外恶性肿瘤的患者与就诊时既无既往也无当前颅外恶性肿瘤的患者术后100天内的复发率差异。前一组患者进一步分为两个亚组：当前患有肿瘤的患者和既往患有肿瘤的患者。统计学显著性定义为P<0.05。
既往或当前患有恶性肿瘤的患者的重复复发率（>2次复发）显著高于无恶性肿瘤的患者（分别为8.5%和1.7%；P=0.01）；首次复发率无显著差异（分别为19.1%和16.2%；P=0.63）。此外，当前患有恶性肿瘤的患者的重复复发率略高于既往患有恶性肿瘤的患者（分别为20.0%和3.1%；P=0.053）。在多变量分析中，单层血肿是首次复发的唯一风险因素（比值比，3.16；P=0.003），而当前患有恶性肿瘤是重复复发的唯一显著风险因素（比值比，16.49；P=0.002）。
恶性肿瘤的存在可能是CSDH重复复发的一个新的预测因素。应密切随访患有恶性肿瘤的患者，可考虑采用皮下储液器置入等治疗方案以预防进一步复发。
