Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
Research Associate, Neuro-oncology Laboratory, Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
World Neurosurg. 2024 Jul;187:e331-e339. doi: 10.1016/j.wneu.2024.04.082. Epub 2024 Apr 20.
Meningiomas are the most frequent primary intracranial tumor. While histological grade and grade of excision are established predictors of recurrence, the predictive ability of other clinical features, such as the role of radical excision of dural attachment and postoperative radiation therapy in intermediate-risk groups, remains unknown.
Clinical and radiological features and surgical details were analyzed in 451 World Health Organization (WHO) grade 1 intracranial meningiomas and 248 WHO grade 2 meningiomas operated on between 2010 and 2015. Outcomes were assessed in 352 WHO grade 1 and 208 WHO grade 2 meningiomas, studying the effect of extent of resection and use of radiation therapy. Kaplan-Meier analysis was used to determine differences in survival by extent of resection and use of postoperative radiation therapy in the treatment of the meningiomas.
The mean age of the cohort was 46.3 years, with a female predominance. On univariate analysis, sex, WHO grade, and Simpson grade were significant predictors of recurrence. On multivariate analysis, WHO grade and Simpson grade remained significant predictors of recurrence. Recurrence was significantly associated with poor performance status and mortality. Postoperative radiation significantly improved progression-free survival among patients with grade 2 meningiomas who underwent gross total resection, but not among patients with grade 1 and grade 2 meningiomas who underwent subtotal resection.
WHO grade and Simpson grade are independent predictors of recurrence in meningiomas. Regardless of WHO grade, gross total resection must be performed when possible, and postoperative radiation therapy may be recommended in grade 2 meningiomas.
脑膜瘤是最常见的原发性颅内肿瘤。虽然组织学分级和切除程度是复发的既定预测因素，但其他临床特征的预测能力，如硬脑膜附着的根治性切除和术后放疗在中危人群中的作用，仍不清楚。
分析了 2010 年至 2015 年间 451 例世界卫生组织（WHO）1 级颅内脑膜瘤和 248 例 WHO 2 级脑膜瘤的临床和放射学特征及手术细节。在 352 例 WHO 1 级和 208 例 WHO 2 级脑膜瘤中评估了预后，研究了切除范围和放疗的效果。采用 Kaplan-Meier 分析确定在脑膜瘤治疗中，切除范围和术后放疗对生存的影响。
该队列的平均年龄为 46.3 岁，女性居多。单因素分析显示，性别、WHO 分级和 Simpson 分级是复发的显著预测因素。多因素分析显示，WHO 分级和 Simpson 分级仍然是复发的显著预测因素。复发与较差的功能状态和死亡率显著相关。术后放疗显著改善了 WHO 2 级脑膜瘤患者行全切除术后的无进展生存率，但对行次全切除的 WHO 1 级和 2 级脑膜瘤患者无改善。
WHO 分级和 Simpson 分级是脑膜瘤复发的独立预测因素。无论 WHO 分级如何，当可能时必须进行全切除，术后放疗可能适用于 WHO 2 级脑膜瘤。
