Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Institute for Neuropathology, University Hospital Münster, Münster, Germany.
Acta Neurochir (Wien). 2019 Aug;161(8):1647-1656. doi: 10.1007/s00701-019-03956-8. Epub 2019 May 31.
Despite considerable rates of recurrence and mortality in atypical meningiomas, reliable predictors for estimating postoperative long-term prognosis remain elusive.
Clinical, histopathological, and radiological variables from 138 patients, including 64 females and 74 males (46% and 54%, median age 62 years), who underwent surgery for intracranial atypical meningioma were retrospectively analyzed. Associations between variables and recurrence and mortality were investigated using uni- and multivariate analyses.
Gross total (GTR) and subtotal resection (STR) was achieved in 81% and 19% of cases, respectively. Within a median follow-up of 62 months, recurrence occurred in 52 (38%) and mortality in 22 (16%) cases. In patients who did not receive adjuvant irradiation, recurrence rates were higher after STR than after GTR (32% vs 63%, p = 0.025). In univariate analyses, only intratumoral calcifications on preoperative MRI (p = 0.012) and the presence of brain invasion in the absence of other histological grading criteria (p = 0.010) were correlated with longer progression-free intervals (PFI). In multivariate analyses, patient age was positively (HR 1.03, 95%CI 1.04-1.05; p = 0.018) and the presence of brain invasion as the only grading criterion (HR 0.37, 95%CI 0.19-0.74; p = 0.005) was negatively related with progression, while rising age at the time of surgery (HR 1.07, 95%CI 1.03-1.12; p = 0.001) was prognostic for mortality.
PFI was longer in brain invasive but otherwise histological benign meningiomas and in tumors displaying calcifications on preoperative MRI. Advancing patient age and lower Karnofsky Performance Score were associated with higher overall mortality.
尽管非典型脑膜瘤的复发率和死亡率相当高，但仍难以找到可靠的预测指标来估计术后的长期预后。
回顾性分析了 138 例接受颅内非典型脑膜瘤手术的患者的临床、组织病理学和影像学资料，包括 64 名女性和 74 名男性（分别占 46%和 54%，中位年龄 62 岁）。使用单变量和多变量分析来研究变量与复发和死亡率之间的关系。
肿瘤全切除（GTR）和次全切除（STR）的比例分别为 81%和 19%。在中位随访 62 个月期间，52 例（38%）患者复发，22 例（16%）患者死亡。在未接受辅助放疗的患者中，STR 后复发率高于 GTR（32%比 63%，p=0.025）。单变量分析显示，术前 MRI 上的肿瘤内钙化（p=0.012）和存在脑侵犯而无其他组织学分级标准（p=0.010）与无进展生存期（PFI）较长相关。多变量分析显示，患者年龄呈正相关（HR 1.03，95%CI 1.04-1.05；p=0.018），而仅有脑侵犯作为唯一的分级标准（HR 0.37，95%CI 0.19-0.74；p=0.005）与进展呈负相关，而手术时的年龄增长（HR 1.07，95%CI 1.03-1.12；p=0.001）与总死亡率相关。
在具有脑侵犯但组织学良性的脑膜瘤和术前 MRI 上显示钙化的肿瘤中，PFI 较长。患者年龄增长和 Karnofsky 表现状态评分降低与总死亡率升高相关。
