揭示脑膜瘤的分子图谱和围手术期类固醇对患者生存的影响。
Uncovering the molecular landscape of meningiomas and the impact of perioperative steroids on patient survival.
机构信息
Department of Neurosurgery, 10Th Military Research Hospital and Polyclinic, 85-681, Bydgoszcz, Poland.
Department of Neurooncology and Radiosurgery, Franciszek Łukaszczyk Oncology Center, 85-796, Bydgoszcz, Poland.
出版信息
Acta Neurochir (Wien). 2023 Jul;165(7):1739-1748. doi: 10.1007/s00701-023-05567-w. Epub 2023 Apr 17.
BACKGROUND
The current literature on meningioma reveals a gap in knowledge regarding the impact of genetic factors on patient survival. Furthermore, there is a lack of data on the relationship between the perioperative use of corticosteroids and patient survival in meningioma patients. Our study aims to overcome these gaps by investigating the correlation between genetic factors and overall survival and the effect of postoperative corticosteroids and other clinical characteristics on patient outcomes in meningioma patients.
METHODS
A retrospective analysis of the medical records of 85 newly diagnosed meningioma patients treated from 2016 to 2017 with follow-up until December 2022 was performed.
RESULTS
NF2 mutations occurred in 60% of tumors, AKT1 mutations in 8.2%, and TRAF7 mutations in 3.6%. Most tumors in the parasagittal region had the NF2 mutation. On the other hand, almost all tumors in the sphenoid ridge area did not have the NF2 mutation. AKT-1-mutated meningiomas had more frequent peritumoral edema. Patients who received steroids perioperatively had worse overall survival (OS) than those without steroids (p = 0.034). Moreover, preoperative peri-meningioma edema also was associated with worse OS (p < 0.003). Contrarily, NF2 mutations did not influence survival.
CONCLUSIONS
The combination of clinical, pathomorphological, and genetic data allows us to characterize the tumor better and assess its prognosis. Corticosteroids perioperatively and peri-meningioma edema were associated with shorter OS, according to our study. Glucocorticoids should be used judiciously for the shortest time required to achieve symptomatic relief.
背景
目前关于脑膜瘤的文献揭示了一个知识空白,即遗传因素对患者生存的影响。此外,关于围手术期使用皮质类固醇与脑膜瘤患者生存的关系,也缺乏相关数据。我们的研究旨在通过研究遗传因素与总生存率的相关性,以及皮质类固醇和其他临床特征对脑膜瘤患者预后的影响,来弥补这些空白。
方法
对 2016 年至 2017 年期间诊断为脑膜瘤的 85 例新发病例的病历进行回顾性分析,随访至 2022 年 12 月。
结果
NF2 突变发生在 60%的肿瘤中,AKT1 突变发生在 8.2%,TRAF7 突变发生在 3.6%。大多数矢状旁区的肿瘤存在 NF2 突变。另一方面,蝶骨嵴区的几乎所有肿瘤都没有 NF2 突变。AKT-1 突变的脑膜瘤更常伴有瘤周水肿。围手术期使用类固醇的患者总生存率(OS)比未使用类固醇的患者差(p=0.034)。此外,术前脑膜瘤周围水肿也与较差的 OS 相关(p<0.003)。相反,NF2 突变并不影响生存。
结论
结合临床、病理形态学和遗传数据,我们可以更好地对肿瘤进行特征描述并评估其预后。根据我们的研究,围手术期和脑膜瘤周围的皮质类固醇及水肿与较短的 OS 相关。应谨慎使用糖皮质激素,并在最短时间内达到缓解症状的目的。