Behbahani Maziar, Skeie Geir Olve, Eide Geir Egil, Hausken Annbjørg, Lund-Johansen Morten, Skeie Bente Sandvei
Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
Department of Neurosurgery, Stavanger University Hospital, Norway.
Neurooncol Pract. 2019 Dec;6(6):438-450. doi: 10.1093/nop/npz011. Epub 2019 Apr 17.
The number of incidental meningiomas has increased because of the increased availability of neuroimaging. Lack of prospective data on the natural history makes the optimal management unclear. We conducted a 5-year prospective study of incidental meningiomas to identify risk factors for tumor growth.
Sixty-four of 70 consecutive patients with incidental meningioma were included. Clinical and radiological status was obtained at 0, 0.5, 1, 1.5, 2, 3, 4, and 5 years. GammaPlan and mixed linear regression modeling were utilized for volumetric analysis with primary endpoint tumor growth.
None of the patients developed tumor-related symptoms during the study period, although 48 (75%) tumors increased (>15%), 13 (20.3%) remained unchanged, and 3 (4.7%) decreased (>15%) in volume. Mean time to growth was 2.2 years (range, 0.5-5.0 years).The growth pattern was quasi-exponential in 26%, linear in 17%, sigmoidal in 35%, parabolic in 17%, and continuous reduction in 5%. There was significant correlation among growth rate, larger baseline tumor volume ( < .001), and age in years (<55 y: 0.10 cm/y, 55-75 y: 0.24 cm/y, and >75 y: 0.85 cm/y).
The majority of meningiomas will eventually grow. However, more than 60% display a self-limiting growth pattern. Our study provides level-2 evidence that asymptomatic tumors can be safely managed utilizing serial imaging until persistent radiological and/or symptomatic growth.
由于神经影像学检查的普及，偶然发现的脑膜瘤数量有所增加。缺乏关于其自然病史的前瞻性数据使得最佳治疗方案尚不明确。我们对偶然发现的脑膜瘤进行了一项为期5年的前瞻性研究，以确定肿瘤生长的危险因素。
连续70例偶然发现脑膜瘤的患者中有64例被纳入研究。在0、0.5、1、1.5、2、3、4和5年时获取临床和影像学资料。使用GammaPlan和混合线性回归模型进行体积分析，以肿瘤生长作为主要终点。
在研究期间，没有患者出现与肿瘤相关的症状，尽管48个（75%）肿瘤体积增大（>15%），13个（20.3%）保持不变（译者注：此处原文有误，根据前文逻辑应是肿瘤体积增大>15%，保持不变的范围应是±15%，此处译文按原文翻译），3个（4.7%）体积减小（>15%）。平均生长时间为2.2年（范围0.5 - 5.0年）。生长模式呈准指数型的占26%，线性型占17%，S型占35%，抛物线型占17%，持续缩小型占5%。生长速率、较大的基线肿瘤体积（P <.001）和年龄（<55岁：0.10 cm/年，55 - 75岁：0.24 cm/年，>75岁：0.85 cm/年）之间存在显著相关性。
大多数脑膜瘤最终会生长。然而，超过60%表现出自我限制的生长模式。我们的研究提供了二级证据，表明无症状肿瘤可以通过连续影像学检查安全管理，直到出现持续的影像学和/或症状性生长。
