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世界卫生组织 I 级脑膜瘤:生存预后因素的分类树。

WHO grade I meningiomas: classification-tree for prognostic factors of survival.

机构信息

Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.

Service de Neurochirurgie, Hôpitaux Universitaires de Genève, Rue Gabriel-Perret-Gentil 5, 1205, Genève, Switzerland.

出版信息

Neurosurg Rev. 2020 Apr;43(2):749-758. doi: 10.1007/s10143-019-01117-0. Epub 2019 Jun 10.

Abstract

World Health Organization (WHO) grade I meningiomas are intracranial extracerebral tumors, in which microsurgery as a stand-alone therapy provides high rates of disease control and low recurrence rates. Our aim was to identify prognostic factors of overall survival and time-to-retreat (OS; TTR) in a cohort of patients with surgically managed WHO grade I meningioma. Patients with WHO grade I meningiomas from a retrospectively (1990 to 2002) and prospectively managed (2003 to 2010) databank of Oslo University Hospital, Norway, were included. The mean follow-up was 9.2 ± 5.7 years, with a total of 11,414 patient-years. One thousand three hundred fifty-five patients were included. The mean age was 58 ± 13.2, mean Karnofsky Performance Status (KPS) 92.6 ± 26.1 and female-to-male ratio 2.5:1. The 1-year, 5-year, 10-year, 15-year, and 20-year probabilities were 0.98, 0.91, 0.87, 0.84, and 0.8 for TTR. Patient age (OR 0.92 [0.91, 0.94]), male sex (OR 0.59 [0.45, 0.76]), preoperative KPS ≥ 70 (OR 2.22 [1.59, 3.13]), skull base location (OR 0.77 [0.60, 1]), and the occurrence of a postoperative hematoma (OR 0.44 [0.26, 0.76]) were identified as independent prognostic factors of OS. Patient age (OR 1.02 [1.01, 1.03]) and skull base location (OR 0.30 [0.21, 0.45]) were independent predictors of decreased PFS. Using a recursive partitioning analysis, we suggest a classification tree for the prediction of 5-year PFS based on patient and tumor characteristics. The findings from this cohort of meningioma WHO I patients helps to identify patients at risk of recurrence and tailor the therapeutic management.

摘要

世界卫生组织(WHO)一级脑膜瘤是颅内外肿瘤,单纯手术作为一种独立的治疗方法,可提供较高的疾病控制率和较低的复发率。我们的目的是确定一组接受手术治疗的 WHO 一级脑膜瘤患者的总生存和无进展生存时间(OS;TTR)的预后因素。

从挪威奥斯陆大学医院回顾性(1990 年至 2002 年)和前瞻性(2003 年至 2010 年)管理的数据库中纳入了 WHO 一级脑膜瘤患者。平均随访时间为 9.2±5.7 年,总随访时间为 11414 患者年。共纳入 1355 例患者。平均年龄为 58±13.2 岁,平均卡氏功能状态评分(KPS)为 92.6±26.1,女性与男性的比例为 2.5:1。TTR 的 1 年、5 年、10 年、15 年和 20 年的概率分别为 0.98、0.91、0.87、0.84 和 0.8。患者年龄(OR 0.92[0.91,0.94])、男性(OR 0.59[0.45,0.76])、术前 KPS≥70(OR 2.22[1.59,3.13])、颅底位置(OR 0.77[0.60,1])和术后血肿的发生(OR 0.44[0.26,0.76])被确定为 OS 的独立预后因素。患者年龄(OR 1.02[1.01,1.03])和颅底位置(OR 0.30[0.21,0.45])是 PFS 降低的独立预测因素。

通过递归分区分析,我们根据患者和肿瘤特征,提出了一个用于预测 5 年 PFS 的分类树。对这组 WHO 一级脑膜瘤患者的研究结果有助于识别复发风险患者,并制定治疗管理策略。

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