Radiopathologic predictors of recurrence in patients with a gross totally resected atypical meningioma
Radiopathologic predictors of recurrence in patients with a gross totally resected atypical meningioma
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DOI：
10.1080/01616412.2021.2022915
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发表时间：
2021-12-31
影响因子：
1.9
通讯作者：
Alimohammadi, Ehsan
中科院分区：
文献类型：
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作者：
Anand, Sharath Kumar;Sardari, Hamid;Alimohammadi, Ehsan
背景：非典型脑膜瘤（AM）是一种非均匀的脑膜瘤聚集体，其局部复发率高于良性脑膜瘤。虽然次全切除后的辅助治疗是标准的，但在总全切除（GTR）后使用辅助治疗仍然存在争议。本研究旨在通过确定GTR AM患者复发的放射病理学预测因素来补充文献，并更好地确定那些可能从辅助治疗中受益的患者。方法回顾性分析2010年4月至2019年4月在本中心连续接受AM全切除术的103例患者。复发定义为MRI上新的强化肿块，无需活检确认。累积发生率图用于估计生存率，log-rank检验用于评估组间差异。采用Cox比例风险模型评估放射病理变量对复发风险的影响。结果103例患者中，女性68例（66.0%），平均年龄51.1±11.4岁。术后患者的中位总生存期为71个月，而中位无进展生存期为64个月。36例（35.0%）患者出现复发。与GTR后AM复发相关的因素包括瘤周水肿（p = 0.005）、坏死（p < 0.001）、有丝分裂率大于7/10高倍视场（HPF） （p < 0.001）、ki67> 15% （p < 0.001）。然而，通过Cox比例风险回归分析，只有有丝分裂率大于7/10HPF （p = 0.018）和ki67> 15% （p = 0.035）与AM复发显著相关。结论高有丝分裂指数（大于7/10 HPF）和Ki67（大于15%）是GTR AM患者复发的独立预测因子。这些发现有助于对可能受益于辅助治疗的患者进行分层。
Background Atypical meningiomas (AM) comprise a heterogeneous conglomeration of meningiomas with higher local recurrence rates than their benign counterparts. Although adjuvant therapy following subtotal resection is the standard, the use of adjuvant therapy following gross total resection (GTR) remains controversial. This study seeks to add to the literature by identifying radiopathologic predictors of recurrence in patients with a GTR AM and better identify those patients who may benefit from adjuvant therapy. Methods A total of 103 consecutive patients who received gross total resection for AM at our center between Apr 2010 and Apr 2019 were evaluated retrospectively. Recurrence was defined as new enhancing masses on MRI without requiring biopsy confirmation. Cumulative incidence plots were used to estimate survival, and the log-rank test was used to assess differences between groups. Cox proportional hazards models were used to evaluate the effect of radiopathologic variables on the hazard of recurrence. Results Of the 103 patients included in this study, 68 (66.0%) were female, and the mean age was 51.1 +/- 11.4. The median overall survival for patients following surgery was 71 months while the median progression-free survival was 64 months. Recurrence occurred in 36 (35.0%) patients. Factors correlated with AM recurrence following GTR included peritumoral edema (p = 0.005), necrosis (p < 0.001), mitotic rate greater than 7/10 high-power field (HPF) (p < 0.001), and Ki67 > 15% (p < 0.001). However, following Cox proportional hazards regression analysis, only mitotic rate greater than 7/10HPF (p = 0.018) and Ki67 > 15% (p = 0.035) were significantly associated with AM recurrence. Conclusions Our results showed high mitotic index (greater than 7/10 HPF) and Ki67 greater than 15% as independent predictors of recurrence in patients with a GTR AM. These findings could help stratify patients who may benefit from adjuvant therapy.