Department of Neurosurgery, Lariboisière Hospital, 75010 Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA Team, Université de Paris, France.
Agence régionale de santé, 2bis, Avenue Georges Brassens, CS 61002 - 97743, Saint Denis Cedex 9, France.
Clin Neurol Neurosurg. 2020 Nov;198:106236. doi: 10.1016/j.clineuro.2020.106236. Epub 2020 Sep 23.
There is no dedicated study on outcome after meningioma surgery in neurofibromatosis type 2 (NF2) patients.
We processed the French Système National des Données de Santé (SNDS) database using an algorithm combining the type of surgical procedure and the International Classification of Diseases to retrieve cases of meningioma operated in NF2 patients between 2007 and 2017. Descriptive and survival analyses were performed.
This nationwide study found 184 patients who were operated on for 315 meningiomas over a 10-year period. 57.6 % were female, median age at first surgery was 40 years IQR[24.8-50.2] and 10.9 % were under 18 years. Cranial convexity (23.4 %) and posterior skull base (16.8 %) were the most common locations. 89.7 % of the tumours were benign and 3.3 % malignant. 16.3 % of the patient received radiotherapy and 13.6 % stereotactic radiosurgery. Median follow-up was 6.3 years, IQR[5.3-7]. At data collection, 28 patients were dead (15.2 %) and median age at death was 41.7 years, IQR [32.7-50.4]. 5 patients died within the year of meningioma surgery. OS rates at 5 and 10 years were: 87.8 %, 95 %CI[82.6-93.3] and 73.2 %, 95 %CI[63.7-84.1] respectively. In univariable Cox regression analysis, Mortality-Related Morbidity Index (MRMI) (HR = 1.57, 95 %CI[1.3-1.9], p < 0.001) Expenditure-Related Morbidity Index (HR1.16, 95 %CI[1.09-1.24], p < 0.001), a malignant meningioma (HR=8.15, 95 %CI[2.78-23.85], p < 0.001), and a diagnosis of deafness or vestibular schwannoma (HR=2.52, 95 %CI[1.02-6.23], p = 0.0447), were associated to the outcome. In multivariable analysis, solely the MRMI and a malignant meningioma remained significant predictors of reduce OS.
Using this unique database, we found that outcome of NF2 patients after meningioma surgery is impaired, especially for those with significant co-morbidities and affected by a malignant meningioma.
目前尚无专门针对神经纤维瘤病 2 型（NF2）患者脑膜瘤手术后结局的研究。
我们使用一种算法处理法国国家健康数据系统（SNDS）数据库，该算法结合了手术类型和国际疾病分类，以检索 2007 年至 2017 年间在 NF2 患者中接受脑膜瘤手术的病例。进行描述性和生存分析。
这项全国性研究共发现 184 例患者在 10 年内接受了 315 例脑膜瘤手术。57.6%为女性，首次手术的中位年龄为 40 岁 IQR[24.8-50.2]，10.9%为 18 岁以下。颅顶凸面（23.4%）和颅后底（16.8%）是最常见的部位。89.7%的肿瘤为良性，3.3%为恶性。16.3%的患者接受了放疗，13.6%的患者接受了立体定向放射外科治疗。中位随访时间为 6.3 年，IQR[5.3-7]。在数据收集时，28 例患者死亡（15.2%），死亡时的中位年龄为 41.7 岁，IQR[32.7-50.4]。5 例患者在脑膜瘤手术后一年内死亡。5 年和 10 年的 OS 率分别为：87.8%，95%CI[82.6-93.3]和 73.2%，95%CI[63.7-84.1]。单变量 Cox 回归分析显示，与死亡率相关的发病率指数（MRMI）（HR=1.57，95%CI[1.3-1.9]，p<0.001）、与支出相关的发病率指数（HR1.16，95%CI[1.09-1.24]，p<0.001）、恶性脑膜瘤（HR=8.15，95%CI[2.78-23.85]，p<0.001）和耳聋或前庭神经鞘瘤诊断（HR=2.52，95%CI[1.02-6.23]，p=0.0447）与结局相关。多变量分析仅显示 MRMI 和恶性脑膜瘤仍然是降低 OS 的显著预测因素。
使用这个独特的数据库，我们发现 NF2 患者脑膜瘤手术后的结局较差，尤其是那些有严重合并症和患有恶性脑膜瘤的患者。
