Li Huan, Zhang Yun-Sheng, Zhang Guo-Bin, Zhang Gui-Jun, Wang Bo, Li Da, Wu Zhen, Zhang Jun-Ting
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Beijing Key Laboratory of Brain Tumor, Beijing, People's Republic of China.
China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Beijing Key Laboratory of Brain Tumor, Beijing, People's Republic of China; Beijing Neurosurgical Institute, Beijing, People's Republic of China; Department of Neurosurgery, Civil Aviation General Hospital, Peking University, Beijing, People's Republic of China.
World Neurosurg. 2019 Feb;122:e1275-e1284. doi: 10.1016/j.wneu.2018.11.032. Epub 2018 Nov 14.
Because of the paucity of relevant data, treatment and outcomes in intracranial atypical meningioma (AM) remain unclear. The aim of this study was to find useful factors predicting survival and to evaluate the role of postoperative radiation after surgery.
Data were obtained from 302 patients with AM who underwent surgery between January 2008 and December 2015.
A series of 302 patients, including 166 female and 136 male, underwent surgery at our institution. Gross total resection (GTR) was achieved in 201 (66.6%) patients. Seventy-five patients (24.8%) underwent postoperative radiation after surgery. For the entire cohort, there were 131 (43.4%) recurrences, 1 (0.33%) metastasis, and 56 (18.5%) mortalities during a median follow-up duration of 41.6 months. The median recurrence-free survival (RFS) was 55.2 months after the date of the first AM surgery, with 1-year, 3-year, and 5-year RFS rates of 87.6%, 63.3% and 47.7%, respectively. The median overall survival (OS) for patients was 99.8 months, and the actuarial OS rates from the time of the first AM surgery at 1, 3, and 5 years were 97.0%, 90.6%, and 78.8%, respectively. In multivariate analysis, preoperative Karnofsky Performance Scale score (≥80), primary tumor, tumor invasiveness, and GTR were associated with increased RFS, whereas preoperative Karnofsky Performance Scale score (≥80), primary tumor, supratentorial location, lack of peritumoral edema, radiotherapy, and GTR were associated with increased OS.
GTR is the first choice for patients with AM. We recommend that patients with secondary tumors receive radiotherapy after surgery.
由于相关数据匮乏，颅内非典型脑膜瘤（AM）的治疗方法及预后仍不明确。本研究旨在寻找预测生存的有用因素，并评估术后放疗的作用。
数据来自2008年1月至2015年12月期间接受手术的302例AM患者。
本机构共对302例患者进行了手术，其中女性166例，男性136例。201例（66.6%）患者实现了肿瘤全切除（GTR）。75例（24.8%）患者术后接受了放疗。在中位随访期41.6个月内，整个队列中有131例（43.4%）复发，1例（0.33%）转移，56例（18.5%）死亡。首次AM手术后的中位无复发生存期（RFS）为55.2个月，1年、3年和5年的RFS率分别为87.6%、63.3%和47.7%。患者的中位总生存期（OS）为99.8个月，首次AM手术后1年、3年和5年的精算OS率分别为97.0%、90.6%和78.8%。多因素分析显示，术前卡氏功能状态评分（≥80）、原发肿瘤、肿瘤侵袭性和GTR与RFS增加相关，而术前卡氏功能状态评分（≥80）、原发肿瘤、幕上位置、无瘤周水肿、放疗和GTR与OS增加相关。
GTR是AM患者的首选治疗方式。我们建议继发肿瘤患者术后接受放疗。
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