Byun Hwa Kyung, Chang Won Ick, Lee Joo Ho, Park Chul-Kee, Kim In Ah, Kim Chae-Yong, Cho Jaeho, Kim Eui Hyun, Chang Jong Hee, Kang Seok-Gu, Moon Ju Hyung, Lee Sang Hyung, Lee Jason Joon Bock, Kim Il Han, Suh Chang-Ok, Wee Chan Woo, Yoon Hong In
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Front Oncol. 2022 Jul 1;12:877244. doi: 10.3389/fonc.2022.877244. eCollection 2022.
We aimed to compare the outcomes of adjuvant radiotherapy (ART) and surveillance in patients with grade 2 meningiomas (MNG2) who underwent surgical resection.
Data from four hospitals, in which patients aged ≥18 years underwent Simpson grade 1-4 surgical resection for newly diagnosed MNG2 between 1998 and 2018, were examined in this multicenter retrospective cohort study. Patients receiving ART with conventional fractionation were compared with those undergoing surveillance. Progression-free survival (PFS), progression/recurrence (P/R) were evaluated.
This study included 518 patients, 158 of whom received ART. The median follow-up duration was 64.9 months. In the total cohort, ART was independently associated with significantly improved PFS (HR, 0.35; 95% CI, 0.23-0.55; P<0.001) and P/R (HR, 0.30; 95% CI, 0.18-0.48; P<0.001). In the propensity score-matched cohort (n=143 in each group), the 5-year PFS rates were 80.8% and 57.7% (P=0.004), and the 5-year P/R rates were 16.5% and 40.0% (P=0.002) in the ART and surveillance groups, respectively. After gross total resection, the 5-year PFS (85.0% vs. 64.7%; P=0.020) and P/R rates (15.2% vs. 32.0%; P=0.035) were significantly better in the ART group than in the surveillance group. A model for P/R was developed using recursive partitioning analysis with surgical extent, tumor size, and Ki-67 index. ART reduced the risk of P/R in the low- (P=0.069), intermediate- (P=0.044), and high-risk groups (P<0.001). Local control was also significantly enhanced by ART among all the risk groups (all P<0.05).
ART significantly improved PFS and P/R in patients with MNG2, irrespective of the surgical extent, and can be recommended after gross total resection. A prognostic model may guide decision-making for the use of ART.
我们旨在比较接受手术切除的2级脑膜瘤（MNG2）患者辅助放疗（ART）与观察等待的疗效。
本多中心回顾性队列研究分析了四家医院的数据，这些医院中年龄≥18岁的患者在1998年至2018年间因新诊断的MNG2接受了辛普森1 - 4级手术切除。将接受常规分割ART的患者与接受观察等待的患者进行比较。评估无进展生存期（PFS）、进展/复发（P/R）情况。
本研究纳入518例患者，其中158例接受了ART。中位随访时间为64.9个月。在整个队列中，ART与显著改善的PFS（风险比[HR]，0.35；95%置信区间[CI]，0.23 - 0.55；P<0.001）和P/R（HR，0.30；95% CI，0.18 - 0.48；P<0.001）独立相关。在倾向评分匹配队列（每组n = 143）中，ART组和观察等待组的5年PFS率分别为80.8%和57.7%（P = 0.004），5年P/R率分别为16.5%和40.0%（P = 0.002）。在全切术后，ART组的5年PFS（85.0%对64.7%；P = 0.020）和P/R率（15.2%对32.0%；P = 0.035）显著优于观察等待组。使用递归划分分析结合手术范围、肿瘤大小和Ki-67指数建立了P/R模型。ART降低了低风险（P = 0.069）、中风险（P = 0.044）和高风险组（P<0.001）的P/R风险。在所有风险组中，ART也显著提高了局部控制率（所有P<0.05）。
无论手术范围如何，ART均显著改善了MNG2患者的PFS和P/R，全切术后可推荐使用。一个预后模型可能会指导ART使用的决策制定。
