INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA team, Université Diderot - Paris 7, USPC, Paris, France.
Department of Neurosurgery, NHNN, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Neurosurgery. 2019 Sep 1;85(3):E461-E469. doi: 10.1093/neuros/nyy610.
In contrast to benign meningiomas, malignant meningiomas (MM) are rare and associated with an unfavourable prognosis. Reports on MM concern fairly small cohorts, often comprising less than 30 cases.
To describe the outcome MM and identify factors that may influence survival.
Pathology reports and clinical data of 178 patients treated between 1989 and 2017 for a MM at 6 different international institutions were retrospectively reviewed. Seventy-six patients (42.7%) had a previous history of grade I or grade II meningioma. The patients underwent a total of 380 surgical resections and 72.5% received radiotherapy. Median follow-up was 4.5 yr.
At data collection, 111 patients were deceased (63.4%) and only 23 patients (13.7%) were alive without any residual tumor on the most recent scan. Median overall survival was 2.9 yr, 95% confidence interval [CI; 2.4, 4.5]. Overall survival rates at 1, 5, and 10 yr, respectively, were: 77.7%, 95% CI [71.6, 84.3], 40%, 95% CI [32.7, 49], and 27.9%, 95% CI [20.9, 37.3]. In the multivariable analysis, age at MM surgery <65 yr (hazard ratio [HR] = 0.44, 95% CI [0.29, 0.67], P < .001), previous benign or atypical meningioma surgery (HR = 1.9, 95% CI [1.23, 2.92], P = .004), completeness of resection (HR = 0.51, 95% CI [0.34, 0.78], P = .002), and adjuvant radiotherapy (HR = 0.64, 95% CI [0.42, 0.98], P = .039) were established as independent prognostic factors for survival.
This large series confirms the poor prognosis associated with MM, the treatment of which remains challenging. Patients under 65-yr-old with primary MM may live longer after complete resection and postoperative radiotherapy. Even with aggressive treatments, local control remains difficult to achieve.
与良性脑膜瘤相比，恶性脑膜瘤（MM）较为罕见，且预后较差。关于 MM 的报告涉及的病例通常较少，通常少于 30 例。
描述 MM 的结果并确定可能影响生存的因素。
回顾性分析了 1989 年至 2017 年间在 6 家国际机构接受 MM 治疗的 178 名患者的病理报告和临床数据。76 名患者（42.7%）曾患有一级或二级脑膜瘤。这些患者共接受了 380 次手术切除，72.5%的患者接受了放疗。中位随访时间为 4.5 年。
在数据收集时，111 名患者死亡（63.4%），仅有 23 名患者（13.7%）在最近的扫描中无残留肿瘤，且存活。中位总生存期为 2.9 年，95%置信区间[2.4, 4.5]。1、5、10 年的总生存率分别为：77.7%，95%置信区间[71.6, 84.3]，40%，95%置信区间[32.7, 49]，27.9%，95%置信区间[20.9, 37.3]。在多变量分析中，MM 手术时年龄<65 岁（风险比[HR]为 0.44，95%置信区间[0.29, 0.67]，P<0.001）、有良性或非典型脑膜瘤手术史（HR 为 1.9，95%置信区间[1.23, 2.92]，P=0.004）、切除程度（HR 为 0.51，95%置信区间[0.34, 0.78]，P=0.002）和辅助放疗（HR 为 0.64，95%置信区间[0.42, 0.98]，P=0.039）是生存的独立预后因素。
这项大型研究证实了 MM 预后较差，其治疗仍然具有挑战性。原发性 MM 且年龄<65 岁的患者，在完全切除和术后放疗后可能会活得更长。即使采用积极的治疗方法，局部控制也难以实现。
