Department of Radiation Oncology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Radiation Oncology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama.
Int J Radiat Oncol Biol Phys. 2019 Feb 1;103(2):453-459. doi: 10.1016/j.ijrobp.2018.09.019. Epub 2018 Sep 22.
To assess the local recurrence rate of gross totally resected atypical meningiomas and evaluate for pathologic predictors of recurrence.
All patients meeting the 2016 World Health Organization grade 2 meningioma criteria who received gross total resection were included in this retrospective analysis. A neuropathologist re-reviewed all surgical specimens for the following pathologic factors: brain invasion, macronuclei, necrosis, sheeting architecture, hypercellularity, high nuclear to cytoplasmic ratio, Ki67 proliferative index, mitotic number, and choroid or clear cell histology. Local recurrence and salvage therapy were recorded.
Ninety-seven patients met the inclusion criteria and had a median radiographic follow-up of 53 months (range, 3-153). Necrosis was present in 41 specimens (42%), and brain invasion occurred in 30 (31%). Seventy-six patients (78%) had 3 of 5 World Health Organization grade 2 qualifying atypical features. Median mitotic number and Ki67 index were 3 (0-12) and 15 (2%-55%), respectively. Only Ki67 proliferative index and mitotic number predict for local recurrence. The Kaplan-Meier estimate of local recurrence was 30.3% at 3 years.
In this cohort of gross totally resected atypical meningioma followed with observation, local recurrence occurred in 30.3% at 3 years. Ki67 index and mitotic number predict for local failure and could help stratify patients who would benefit from adjuvant therapy.
评估大体全切除非典型脑膜瘤的局部复发率，并评估复发的病理预测因素。
本回顾性分析纳入了所有符合 2016 年世界卫生组织 2 级脑膜瘤标准并接受大体全切除的患者。神经病理学家重新审查了所有手术标本的以下病理因素：脑侵犯、巨核、坏死、片状结构、细胞丰富度、核浆比高、Ki67 增殖指数、有丝分裂数以及脉络丛或透明细胞组织学。记录局部复发和挽救治疗情况。
97 例患者符合纳入标准，放射影像学随访中位数为 53 个月（范围 3-153）。41 例（42%）标本存在坏死，30 例（31%）发生脑侵犯。76 例（78%）患者有 5 个世界卫生组织 2 级非典型特征中的 3 个。中位有丝分裂数和 Ki67 指数分别为 3（0-12）和 15（2%-55%）。只有 Ki67 增殖指数和有丝分裂数可预测局部复发。Kaplan-Meier 估计的 3 年局部复发率为 30.3%。
在本队列中，对大体全切除的非典型脑膜瘤进行观察随访，3 年内局部复发率为 30.3%。Ki67 指数和有丝分裂数可预测局部失败，有助于分层需要辅助治疗的患者。
