辛普森分级切除在世界卫生组织I级、II级和III级脑膜瘤现代神经外科治疗中的相关性

The Relevance of Simpson Grade Resections in Modern Neurosurgical Treatment of World Health Organization Grade I, II, and III Meningiomas.

作者信息

Ehresman Jeff S, Garzon-Muvdi Tomas, Rogers Davis, Lim Michael, Gallia Gary L, Weingart Jon, Brem Henry, Bettegowda Chetan, Chaichana Kaisorn L

机构信息

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

出版信息

World Neurosurg. 2018 Jan;109:e588-e593. doi: 10.1016/j.wneu.2017.10.028. Epub 2017 Oct 16.

DOI:10.1016/j.wneu.2017.10.028

PMID:29042332

Abstract

OBJECTIVE

The Simpson grading system has played an important role in surgical resections of meningiomas. The aim of this study was to determine if this grading system predicts meningioma recurrence in a modern cohort of patients with tumors of all World Health Organization grades.

METHODS

Adult patients who underwent primary, nonbiopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate proportional hazard analyses were used to identify associations with recurrence after resection. Log-rank analyses were used to compare Kaplan-Meier plots for time to recurrence between each Simpson grade.

RESULTS

Of 572 patients who met inclusion criteria, 72 (12.6%) presented with recurrence. Factors associated with recurrence after gross total resection (Simpson grades I-III) were non-World Health Organization grade I (hazard ratio [HR] [95% confidence interval (CI)] 6.215 [2.864-12.419], P < 0.0001) and preoperative neurologic deficits (HR [95% CI] 2.862 [1.512-5.499], P = 0.001). Factors associated with recurrence after subtotal resections (Simpson IV) were African American race (HR [95% CI] 2.776 [1.232-5.890], P = 0.02) and parafalcine location (HR [95% CI] 3.956 [1.624-8.775], P = 0.004). Simpson grade was not an independent risk factor for recurrence.

CONCLUSIONS

Identification and consideration of factors associated with recurrence after gross total or subtotal resections may help guide treatment strategies for patients with meningiomas.

摘要

目的

辛普森分级系统在脑膜瘤手术切除中发挥了重要作用。本研究的目的是确定该分级系统能否预测现代队列中所有世界卫生组织分级的肿瘤患者的脑膜瘤复发情况。

方法

回顾性分析2007年至2015年在三级医疗机构接受原发性、非活检性脑膜瘤切除术的成年患者。采用逐步多变量比例风险分析来确定与切除后复发的相关性。采用对数秩分析比较各辛普森分级之间复发时间的Kaplan-Meier曲线。

结果

在572例符合纳入标准的患者中，72例（12.6%）出现复发。与全切除术后（辛普森分级I-III）复发相关的因素为非世界卫生组织I级（风险比[HR][95%置信区间（CI）]6.215[2.864-12.419]，P<0.0001）和术前神经功能缺损（HR[95%CI]2.862[1.512-5.499]，P=0.001）。与次全切除术后（辛普森IV级）复发相关的因素为非裔美国人种族（HR[95%CI]2.776[1.232-5.