Stafford S L, Perry A, Suman V J, Meyer F B, Scheithauer B W, Lohse C M, Shaw E G
Division of Radiation Oncology, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1998 Oct;73(10):936-42. doi: 10.4065/73.10.936.
To establish prognostic factors for recurrence and outcome of surgical treatment, with or without postoperative radiation therapy, in patients with meningiomas.
From 1978 through 1988, 581 patients underwent initial resection of a previously untreated primary meningioma at Mayo Clinic Rochester. In this study cohort, the outcome and prognostic factors associated with radiographic progression-free survival were analyzed.
Gross total resection (GTR) of the meningioma was accomplished in 80% of patients; the other 20% underwent less than GTR. Perioperative mortality within 10 days was 1.6%. Overall survival was significantly decreased from that for an age- and sex-matched cohort from the US white population. Progression-free survival at 5 and 10 years was 88% and 75%, respectively, in patients who underwent GTR and 61% and 39%, respectively, in those who underwent less than GTR. Multivariate analysis showed that age younger than 40 years, male sex, less than GTR, optic nerve involvement, and 4 or more mitotic figures per 10 high-power fields were associated with decreased progression-free survival. The 581 patients had 106 first recurrences. A trend toward improved progression-free survival was noted after first recurrence when irradiation with or without operation was used in comparison with only surgical treatment (P = 0.058).
With only operative treatment of meningioma, the 10-year recurrence rate was 25% in patients who had GTR and 61% in those who had less than GTR. These results emphasize the need for long-term follow-up and for consideration of adjuvant radiation therapy. Patients treated at the time of recurrence seem to benefit from radiation therapy with or without surgical resection. Factors associated with recurrence were (1) less than GTR, (2) involvement of the anterior visual pathway, (3) age younger than 40 years, and (4) increased mitotic index.
确定脑膜瘤患者手术治疗（无论是否联合术后放疗）后复发及预后的相关因素。
1978年至1988年期间，581例患者在梅奥诊所罗切斯特院区接受了未经治疗的原发性脑膜瘤的初次切除术。在该研究队列中，分析了与影像学无进展生存期相关的预后及因素。
80%的患者实现了脑膜瘤的全切除；另外20%的患者切除范围未达到全切除。10天内的围手术期死亡率为1.6%。总体生存率显著低于年龄和性别匹配的美国白人队列。接受全切除的患者5年和10年无进展生存率分别为88%和75%，而切除范围未达到全切除的患者分别为61%和39%。多因素分析显示，年龄小于40岁、男性、切除范围未达到全切除、视神经受累以及每10个高倍视野有4个或更多有丝分裂象与无进展生存期缩短相关。581例患者中有106例首次复发。首次复发后，与单纯手术治疗相比，采用手术联合或不联合放疗时，无进展生存期有改善趋势（P = 0.058）。
仅采用手术治疗脑膜瘤时，接受全切除的患者10年复发率为25%，切除范围未达到全切除的患者为61%。这些结果强调了长期随访以及考虑辅助放疗的必要性。复发时接受治疗的患者似乎从手术联合或不联合放疗中获益。与复发相关的因素有：（1）切除范围未达到全切除；（2）前视觉通路受累；（3）年龄小于40岁；（4）有丝分裂指数增加。
