Department of Radiation Oncology, Northwestern Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
Department of Neurological Surgery, Northwestern Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
Cancer. 2018 Feb 15;124(4):734-742. doi: 10.1002/cncr.31088. Epub 2017 Nov 13.
Atypical and malignant meningiomas are far less common than benign meningiomas. As aggressive lesions, they are prone to local recurrence and may lead to decreased survival. Although malignant meningiomas typically are treated with maximal surgical resection and adjuvant radiotherapy (RT), to the authors' knowledge the optimal treatment for atypical lesions remains to be defined. There are limited prospective data in this setting.
The National Cancer Data Base was queried to investigate cases of histologically confirmed meningiomas diagnosed from 2004 to 2014. This included 7811 patients with atypical meningiomas (World Health Organization grade 2) and 1936 patients with malignant meningiomas (World Health Organization grade 3); during the same period, a total of 60,345 patients were diagnosed with benign meningiomas (World Health Organization grade 1). Data collected included patient and tumor characteristics, extent of surgical resection, and use of RT. Survival analysis was performed using Kaplan-Meier estimates with the log-rank test of significance and Cox univariate and multivariate regression. Logistic regression was used to determine factors associated with use of RT.
The 5-year overall survival rate was 85.5% in patients with benign meningiomas, 75.9% in patients with atypical meningiomas, and 55.4% in patients with malignant meningiomas (P<.0001). In patients with atypical meningiomas, gross (macroscopic) total resection (GTR) and adjuvant RT were found to be associated with significantly improved survival, independently and especially in unison (GTR plus RT: hazard ratio, 0.47; P = .002). On multivariate analysis, the combination of GTR plus RT was found to be the most important factor for improved survival. However, GTR was associated with significantly lower rates of RT use.
GTR and adjuvant RT appear to be highly associated with improved survival, independent of other factors, in patients with atypical meningiomas. Cancer 2018;124:734-42. © 2017 American Cancer Society.
非典型性和恶性脑膜瘤远比良性脑膜瘤少见。作为侵袭性病变，它们容易局部复发，并可能导致生存率降低。尽管恶性脑膜瘤通常采用最大限度的手术切除和辅助放疗（RT）治疗，但据作者所知，非典型病变的最佳治疗方法仍有待确定。在这种情况下，前瞻性数据有限。
国家癌症数据库（National Cancer Data Base）对 2004 年至 2014 年间经组织学证实的脑膜瘤病例进行了调查。这包括 7811 例非典型脑膜瘤（世界卫生组织[WHO] 2 级）和 1936 例恶性脑膜瘤（WHO 3 级）；同期，共有 60345 例患者被诊断为良性脑膜瘤（WHO 1 级）。收集的数据包括患者和肿瘤特征、手术切除范围以及 RT 的使用情况。采用 Kaplan-Meier 估计法进行生存分析，采用对数秩检验进行显著性检验，并采用 Cox 单因素和多因素回归进行分析。采用逻辑回归确定与 RT 使用相关的因素。
良性脑膜瘤患者的 5 年总生存率为 85.5%，非典型脑膜瘤患者为 75.9%，恶性脑膜瘤患者为 55.4%（P<.0001）。在非典型脑膜瘤患者中，肉眼全切除（GTR）和辅助 RT 与生存率显著提高独立相关，特别是两者同时应用时（GTR+RT：风险比，0.47；P = .002）。多因素分析发现，GTR 联合 RT 是改善生存的最重要因素。然而，GTR 与 RT 使用率显著降低相关。
在非典型脑膜瘤患者中，GTR 和辅助 RT 似乎与生存率的提高密切相关，独立于其他因素。癌症 2018；124：734-42。©2017 美国癌症协会。
