Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany.
World Neurosurg. 2019 Nov;131:e321-e328. doi: 10.1016/j.wneu.2019.07.148. Epub 2019 Jul 26.
Anaplastic meningiomas are rare tumors with a poor prognosis, even after complete surgical resection and radiotherapy. There has been limited evidence with respect to the clinical factors and their effects on the course of the disease. Various retrospective studies have not been able to provide clear evidence of standardized treatment, usually presenting contradictory results. The aim of this study was to evaluate the prognostic factors influencing the progression-free survival (PFS) and overall survival (OS) of anaplastic meningiomas, with a particular focus on the roles of the extent of resection and postoperative adjuvant radiotherapy.
Between October 2001 and March 2016, 36 patients with anaplastic meningiomas were treated in our Department of Neurosurgery, of whom 11 underwent gross total resection (GTR) and 18 subtotal resection. Twenty-one patients received postoperative adjuvant radiotherapy, and 8 were treated with surgery alone. GTR (Simpson grades I and II) was associated with significantly improved PFS (P = 0.01) and OS (P = 0.004). Furthermore, adjuvant radiotherapy showed an improvement in PFS (P = 0.01) but not in OS (P = 0.16).
The extent of resection in anaplastic meningiomas is correlated with a better outcome. However, resection alone is not sufficient for the long-term control of anaplastic meningiomas. Adjuvant radiotherapy is an essential component in the adjuvant treatment of anaplastic meningiomas, including for patients undergoing GTR. Further investigations through which to improve adjuvant therapy options are necessary to improve meningioma therapy.
间变性脑膜瘤是一种预后较差的罕见肿瘤，即使在完全手术切除和放疗后也是如此。关于临床因素及其对疾病过程的影响，证据有限。各种回顾性研究未能提供标准化治疗的明确证据，通常得出相互矛盾的结果。本研究旨在评估影响间变性脑膜瘤无进展生存期（PFS）和总生存期（OS）的预后因素，特别关注切除范围和术后辅助放疗的作用。
2001 年 10 月至 2016 年 3 月期间，我院神经外科共治疗 36 例间变性脑膜瘤患者，其中 11 例行大体全切除（GTR），18 例行次全切除。21 例患者接受术后辅助放疗，8 例仅行手术治疗。GTR（Simpson 分级 I 和 II）与显著改善的 PFS（P=0.01）和 OS（P=0.004）相关。此外，辅助放疗改善了 PFS（P=0.01），但未改善 OS（P=0.16）。
间变性脑膜瘤的切除范围与更好的结果相关。然而，单纯切除不足以长期控制间变性脑膜瘤。辅助放疗是间变性脑膜瘤辅助治疗的重要组成部分，包括对接受 GTR 的患者。需要进一步研究以改善辅助治疗选择，从而改善脑膜瘤的治疗效果。
