Condra K S, Buatti J M, Mendenhall W M, Friedman W A, Marcus R B, Rhoton A L
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA.
Int J Radiat Oncol Biol Phys. 1997 Sep 1;39(2):427-36. doi: 10.1016/s0360-3016(97)00317-9.
To examine the effect of primary treatment selection on outcomes for benign intracranial meningiomas at the University of Florida.
For 262 patients, the impact of age, Karnofsky performance status, pathologic features, tumor size, tumor location, and treatment modality on local control and cause-specific survival was analyzed (minimum potential follow-up, 2 years; median follow-up, 8.2 years). Extent of surgery was classified by Simpson grade. Treatment groups: surgery alone (n = 229), surgery and postoperative radiotherapy (RT) (n = 21), RT alone (n = 7), radiosurgery alone (n = 5). Survival analysis: Kaplan-Meier method with univariate and multivariate analysis.
At 15 years, local control was 76% after total excision (TE) and 87% after subtotal excision plus RT (SE+RT), both significantly better (p = 0.0001) than after SE alone (30%). Cause-specific survival at 15 years was reduced after treatment with SE alone (51%), compared with TE (88%) or SE+RT (86%) (p = 0.0003). Recurrence after primary treatment portended decreased survival, independent of initial treatment group or salvage treatment selection (p = 0.001). Atypical pathologic features predicted reduced 15-year local control (54 vs. 71%) and cause-specific survival rates (57 vs. 86%). Multivariate analysis for cause-specific survival revealed treatment group (SE vs. others; p = 0.0001), pathologic features (atypical vs. typical;p = 0.0056), and Karnofsky performance status (> or = 80 vs. < 80; p = 0.0153) as significant variables.
Benign meningiomas are well managed by TE or SE+RT. SE alone is inadequate therapy and adversely affects cause-specific survival. Atypical pathologic features predict a poorer outcome, suggesting possible benefit from more aggressive treatment. Because local recurrence portends lower survival rates, primary treatment choice is important.
研究佛罗里达大学对原发性颅内良性脑膜瘤的治疗选择对治疗结果的影响。
对262例患者，分析年龄、卡氏功能状态、病理特征、肿瘤大小、肿瘤位置及治疗方式对局部控制和病因特异性生存率的影响（最小潜在随访时间为2年；中位随访时间为8.2年）。手术范围按辛普森分级分类。治疗组：单纯手术（n = 229）、手术加术后放疗（RT）（n = 21）、单纯放疗（n = 7）、单纯放射外科手术（n = 5）。生存分析：采用Kaplan-Meier法进行单因素和多因素分析。
15年时，全切（TE）后局部控制率为76%，次全切除加放疗（SE+RT）后为87%，两者均显著优于单纯次全切除（SE）后的局部控制率（30%）（p = 0.0001）。与TE（88%）或SE+RT（86%）相比，单纯SE治疗后15年的病因特异性生存率降低（51%）（p = 0.0003）。初次治疗后复发预示生存率降低，与初始治疗组或挽救治疗选择无关（p = 0.001）。非典型病理特征预示15年局部控制率降低（54%对71%）和病因特异性生存率降低（57%对86%）。病因特异性生存率的多因素分析显示治疗组（SE与其他组；p = 0.0001）、病理特征（非典型与典型；p = 0.0056）和卡氏功能状态（≥80与<80；p = 0.0153）为显著变量。
良性脑膜瘤通过TE或SE+RT可得到良好治疗。单纯SE治疗不足，会对病因特异性生存率产生不利影响。非典型病理特征预示预后较差，提示更积极的治疗可能有益。由于局部复发预示生存率较低，因此初次治疗选择很重要。
