Meling Torstein R, Da Broi Michele, Scheie David, Helseth Eirik, Smoll Nicolas R
Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway; Department of Neurosurgery, Geneva University Medical Center, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Faculty of Medicine, University of Oslo, Oslo, Norway.
World Neurosurg. 2019 May;125:e205-e213. doi: 10.1016/j.wneu.2019.01.042. Epub 2019 Jan 24.
To study improvements in outcomes after surgery for intracranial meningiomas.
We performed a longitudinal observational study comparing 1469 patients operated on for intracranial meningioma in 4 consecutive time frames (1990-1994, 1995-1999, 2000-2004, and 2005-2010).
Median age at surgery was 58.3 years. Median follow-up was 7 years. Patients in later periods were older than in the earlier ones (odds ratio [OR], 1.19 [1.09-1.32]; P < 0.0005), indicating a trend toward operating on more elderly patients. Before 2000, 42%, 32%, 6%, 19%, and 0.3% achieved Simpson grade (SG) I, II, III, IV, and V, respectively, whereas the SG rates were 35%, 37%, 4%, 23%, and 0.9% after 2000 (OR, 1.18 [1.06-1.30]; P < 0.005). The perioperative mortality (OR, 0.65 [0.46-0.91]; P < 0.05) and worsened neurologic outcome rate (OR, 0.70 [0.60-0.83]; P < 0.0001) were significantly lower in later decades, but the 4 surgical periods were similar regarding postoperative infections and hematomas. Retreatment-free survival (RFS) and overall survival (OS) increased significantly over the 4 time frames (P < 0.05 and P < 0.0001, respectively). Multivariate analysis confirmed the improvement of surgical radicality, neurologic outcome, perioperative mortality, OS, and RFS.
Meningioma surgery as well as patient population changed over the 2 decades considered in this study. We observed higher rates of gross total resection in the later period and the perioperative outcomes improved or were unchanged, which signifies better long-term outcomes, RFS, and OS.
研究颅内脑膜瘤手术后预后的改善情况。
我们进行了一项纵向观察性研究，比较了连续4个时间段（1990 - 1994年、1995 - 1999年、2000 - 2004年和2005 - 2010年）接受颅内脑膜瘤手术的1469例患者。
手术时的中位年龄为58.3岁。中位随访时间为7年。后期的患者比早期的患者年龄更大（优势比[OR]，1.19[1.09 - 1.32]；P < 0.0005），表明存在对更多老年患者进行手术的趋势。2000年前，分别有42%、32%、6%、19%和0.3%的患者达到辛普森分级（SG）I、II、III、IV和V级，而2000年后的SG率分别为35%、37%、4%、23%和0.9%（OR，1.18[1.06 - 1.30]；P < 0.005）。后期几十年的围手术期死亡率（OR，0.65[0.46 - 0.91]；P < 0.05）和神经功能恶化率（OR，0.70[0.60 - 0.83]；P < 0.0001）显著更低，但4个手术时间段在术后感染和血肿方面相似。无再次治疗生存期（RFS）和总生存期（OS）在4个时间段内均显著增加（分别为P < 0.05和P < 0.0001）。多因素分析证实了手术根治性、神经功能预后、围手术期死亡率、OS和RFS的改善。
在本研究考虑的20年中，脑膜瘤手术以及患者群体发生了变化。我们观察到后期的全切除率更高，围手术期预后得到改善或保持不变，这意味着长期预后、RFS和OS更好。
