Division of Neurosurgery, Kusatsu General Hospital, Yabase-cho 1660, Kusatsu, Shiga, 525-8585, Japan.
Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan.
Brain Tumor Pathol. 2021 Apr;38(2):81-95. doi: 10.1007/s10014-020-00390-y. Epub 2021 Jan 6.
The WHO 2016 classification introduced brain invasion as a standalone criterion for grade II meningioma (GIIM). We systematically reviewed studies published after 2000 and performed a PRISMA-compliant meta-analysis of the hazard ratios (HRs) for progression-free survival (PFS) between brain-invasive and noninvasive meningiomas. In five studies that included both benign and higher-grade meningiomas, brain invasion was a significant risk factor for recurrence (HR = 2.45, p = 0.0004). However, in 3 studies comparing "brain-invasive meningioma with otherwise benign histology (BIOB)" with grade I meningioma, brain invasion was not a significant predictor of PFS (HR = 1.49, p = 0.23). Among GIIM per the WHO 2000 criteria, brain invasion was a significant predictor of shorter PFS than noninvasive GIIM (HR = 3.40, p = 0.001) but not per the WHO 2016 criteria (HR 1.13, p = 0.54), as the latter includes BIOB. Meta-regression analysis of seven studies of grade II meningioma showed that more frequent BIOB was associated with lower HRs (p < 0.0001). Hence, there is no rationale for brain invasion as a standalone criterion for grade II meningioma, although almost all studies were retrospective and exhibited highly heterogeneous HRs due to differences in brain-tumor interface data availability.
世界卫生组织 2016 年分类将脑侵犯作为 II 级脑膜瘤（GIIM）的独立标准。我们系统地回顾了 2000 年后发表的研究，并对无进展生存期（PFS）的风险比（HR）进行了符合 PRISMA 标准的荟萃分析，比较了脑侵犯和非侵犯性脑膜瘤之间的差异。在包括良性和高级别脑膜瘤的 5 项研究中，脑侵犯是复发的显著危险因素（HR=2.45，p=0.0004）。然而，在 3 项比较“具有脑侵犯特征但组织学良性的脑膜瘤（BIOB）”与 I 级脑膜瘤的研究中，脑侵犯并不是 PFS 的显著预测因子（HR=1.49，p=0.23）。在 2000 年 WHO 分级的 GIIM 中，脑侵犯是 PFS 较短的显著预测因子，而非 2016 年 WHO 分级的 GIIM（HR=3.40，p=0.001），因为后者包括了 BIOB。对 7 项 II 级脑膜瘤研究的荟萃回归分析显示，更频繁的 BIOB 与更低的 HR 相关（p<0.0001）。因此，脑侵犯作为 II 级脑膜瘤的独立标准没有任何依据，尽管几乎所有研究都是回顾性的，并且由于脑肿瘤界面数据可用性的差异，HR 存在高度异质性。
