原发性和继发性间变性脑膜瘤：临床和组织分子预后因素研究。
De novo and secondary anaplastic meningiomas: a study of clinical and histomolecular prognostic factors.
机构信息
Department of Neurosurgery, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France.
Université Paris VI-Pierre et Marie Curie, Paris, France.
出版信息
Neuro Oncol. 2018 Jul 5;20(8):1113-1121. doi: 10.1093/neuonc/nox231.
BACKGROUND
Following recent studies underlining the differences between de novo and secondary anaplastic meningiomas and the prognostic value of telomerase reverse transcriptase (TERT) promoter mutation, we decided to conduct a multicenter retrospective study to address these questions and determine specific prognostic factors in each of these 2 anaplastic meningioma subgroups.
METHODS
Among the 68 meningioma cases initially selected, only 57 were confirmed as anaplastic meningiomas after centralized pathological review. TERT promoter mutation analysis was performed in all cases.
RESULTS
Median overall survival was 2.6 years and 5-year survival rate was 10%. This study confirmed the better prognosis of de novo anaplastic meningiomas (28 tumors) compared with secondary anaplastic meningiomas (29 tumors) (P = 0.02). In the "de novo" group, meningiomas diagnosed on histological anaplasia alone had a better prognosis than those in patients with a high number of mitoses with or without anaplasia (P = 0.01). In the "secondary" group, tumors demonstrate very heterogeneous clinical courses leading to malignant transformation, and time to first relapse as a low-grade tumor was a strong predictor of overall survival (P = 0.0007). TERT promoter mutation in anaplastic meningiomas was rare (14%) and did not influence overall survival but was associated with a shorter recurrence-free survival in the secondary anaplastic meningioma subgroup (P = 0.02). The absence of TERT promoter methylation, although rare (3/33 cases), may be associated with prolonged overall survival (P = 0.02).
CONCLUSION
This study highlights the different prognoses of de novo and secondary anaplastic meningiomas with specific prognostic factors in each subgroup. The analysis of TERT mutation and methylation could provide additional prognostic insights.
背景
最近的研究强调了初发型和继发型间变性脑膜瘤之间的差异，以及端粒酶逆转录酶（TERT）启动子突变的预后价值。因此，我们决定进行一项多中心回顾性研究，以解决这些问题，并确定这两个间变性脑膜瘤亚组中的特定预后因素。
方法
在最初选择的 68 例脑膜瘤病例中，只有 57 例经集中病理复查后确诊为间变性脑膜瘤。所有病例均进行了 TERT 启动子突变分析。
结果
中位总生存期为 2.6 年，5 年生存率为 10%。本研究证实，与继发型间变性脑膜瘤（29 例）相比，初发型间变性脑膜瘤（28 例）的预后更好（P=0.02）。在“初发型”组中，仅在组织学上表现为间变的脑膜瘤比伴有或不伴有间变的高有丝分裂数的脑膜瘤的预后更好（P=0.01）。在“继发型”组中，肿瘤表现出非常异质的临床过程，导致恶性转化，而作为低级别肿瘤的首次复发时间是总生存期的强有力预测因素（P=0.0007）。间变性脑膜瘤中 TERT 启动子突变罕见（14%），并不影响总生存期，但与继发型间变性脑膜瘤亚组的无复发生存期较短相关（P=0.02）。虽然 TERT 启动子甲基化罕见（3/33 例），但可能与总生存期延长相关（P=0.02）。
结论
本研究强调了初发型和继发型间变性脑膜瘤的不同预后，并在每个亚组中确定了特定的预后因素。TERT 突变和甲基化分析可以提供额外的预后信息。
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