1Department of Neurological Surgery, University of California, San Francisco.
2School of Medicine, University of California, San Francisco.
J Neurosurg. 2022 Jun 3;138(1):86-94. doi: 10.3171/2022.4.JNS212516. Print 2023 Jan 1.
Meningiomas are the most common primary intracranial tumor, and resection is a mainstay of treatment. It is unclear what duration of imaging follow-up is reasonable for WHO grade I meningiomas undergoing complete resection. This study examined recurrence rates, timing of recurrence, and risk factors for recurrence in patients undergoing a complete resection (as defined by both postoperative MRI and intraoperative impression) of WHO grade I meningiomas.
The authors conducted a retrospective, single-center study examining recurrence risk for adult patients with a single intracranial meningioma that underwent complete resection. Uni- and multivariate nominal logistic regression and Cox proportional hazards analyses were performed to identify variables associated with recurrence and time to recurrence. Two supervised machine learning algorithms were then implemented to confirm factors within the cohort that were associated with recurrence.
The cohort consisted of 823 patients who met inclusion criteria, and 56 patients (6.8%) had recurrence on imaging follow-up. The median age of the cohort was 56 years, and 77.4% of patients were female. The median duration of head imaging follow-up for the entire cohort was 2.7 years, but for the subgroup of patients who had a recurrence, the median follow-up was 10.1 years. Estimated 1-, 5-, 10-, and 15-year recurrence-free survival rates were 99.8% (95% confidence interval [CI] 98.8%-99.9%), 91.0% (95% CI 87.7%-93.6%), 83.6% (95% CI 78.6%-87.6%), and 77.3% (95% CI 69.7%-83.4%), respectively, for the entire cohort. On multivariate analysis, MIB-1 index (odds ratio [OR] per 1% increase: 1.34, 95% CI 1.13-1.58, p = 0.0003) and follow-up duration (OR per year: 1.12, 95% CI 1.03-1.21, p = 0.012) were both associated with recurrence. Gradient-boosted decision tree and random forest analyses both identified MIB-1 index as the main factor associated with recurrence, aside from length of imaging follow-up. For tumors with an MIB-1 index < 8, recurrences were documented up to 8 years after surgery. For tumors with an MIB-1 index ≥ 8, recurrences were documented up to 12 years following surgery.
Long-term imaging follow-up is important even after a complete resection of a meningioma. Higher MIB-1 labeling index is associated with greater risk of recurrence. Imaging screening for at least 8 years in patients with an MIB-1 index < 8 and at least 12 years for those with an MIB-1 index ≥ 8 may be needed to detect long-term recurrences.
脑膜瘤是最常见的原发性颅内肿瘤，切除术是主要的治疗方法。对于完全切除的 WHO 1 级脑膜瘤，进行何种时间长度的影像学随访尚不清楚。本研究旨在检测完全切除（定义为术后 MRI 和术中印象）的 WHO 1 级脑膜瘤患者的复发率、复发时间和复发风险因素。
作者进行了一项回顾性、单中心研究，研究对象为接受完全切除的单一颅内脑膜瘤的成年患者。进行单变量和多变量名义逻辑回归和 Cox 比例风险分析，以确定与复发和复发时间相关的变量。然后实施了两种监督机器学习算法，以确认队列中与复发相关的因素。
该队列包括符合纳入标准的 823 名患者，其中 56 名（6.8%）在影像学随访中复发。该队列的中位年龄为 56 岁，77.4%的患者为女性。整个队列的头部影像学随访中位时间为 2.7 年，但对于复发亚组患者，中位随访时间为 10.1 年。估计的 1、5、10 和 15 年无复发生存率分别为 99.8%（95%置信区间[CI] 98.8%-99.9%）、91.0%（95%CI 87.7%-93.6%）、83.6%（95%CI 78.6%-87.6%）和 77.3%（95%CI 69.7%-83.4%）。多变量分析显示，MIB-1 指数（每增加 1%的比值比[OR]：1.34，95%CI 1.13-1.58，p = 0.0003）和随访时间（每年的 OR：1.12，95%CI 1.03-1.21，p = 0.012）均与复发相关。梯度提升决策树和随机森林分析均发现，除了影像学随访时间外，MIB-1 指数也是与复发相关的主要因素。对于 MIB-1 指数<8 的肿瘤，手术后 8 年内可记录到复发。对于 MIB-1 指数≥8 的肿瘤，手术后 12 年内可记录到复发。
即使脑膜瘤完全切除，也需要长期进行影像学随访。较高的 MIB-1 标记指数与更高的复发风险相关。对于 MIB-1 指数<8 的患者，需要至少进行 8 年的影像学筛查，对于 MIB-1 指数≥8 的患者，需要至少进行 12 年的影像学筛查，以检测长期复发。
