Prognostic value of estrogen receptor in WHO Grade III meningioma: a long-term follow-up study from a single institution
Prognostic value of estrogen receptor in WHO Grade III meningioma: a long-term follow-up study from a single institution
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雌激素受体在 WHO III 级脑膜瘤中的预后价值：来自单一机构的长期随访研究
DOI：
10.3171/2017.2.jns162566
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发表时间：
2018-06-01
影响因子：
4.1
通讯作者：
Gong, Ye
中科院分区：
文献类型：
--
作者：
Hua, Lingyang;Zhu, Hongda;Gong, Ye
目的恶性脑膜瘤是一种少见的脑膜瘤，在WHO的中枢神经系统肿瘤分类中被列为III级。然而，雌激素受体(ER)在WHO III级脑膜瘤中的存在及其与患者预后的相关性仍不清楚。在这项单中心队列研究中，作者分析了这些恶性肿瘤的临床特征、治疗和预后，并进行了长期随访。方法选择2003-2008年间经病理诊断为WHO III级脑膜瘤的87例患者，进行至少7年的随访。结果横纹肌样脑膜瘤12例，乳头状脑膜瘤12例，间变性脑膜瘤63例。平均无进展生存期(PFS)为56.2±49.8个月，总生存期(OS)为68.7±47.4个月。在PFS(p=0.929)或OS(p=0.688)中，3种组织学亚型之间的差异均无统计学意义。接受大部切除的患者比次全切除的患者有更长的PFS(p=0.001)和OS(p=0.027)。辅助放射治疗与OS相关(p=0.034)，与PFS无关(p=0.433)。与原发脑膜瘤相比，复发患者的PFS更差(p<；0.001)。对于有恶变的患者，在PFS(p=0.002)和OS(p=0.019)方面，预后都比没有恶变的患者差。在PFS(p=0.003)和OS(p<；0.001)方面，ER阳性患者的预后明显比ER阴性患者差，但未观察到孕激素受体与患者预后之间的关系。多因素分析显示ER表达是PFS(p=0.008)和OS(p<；0.001)的独立预后因素。结论本次回顾性研究显示，ER阳性脑膜瘤患者的预后明显差于ER弱阳性或ER阴性脑膜瘤患者。提示ER是影响WHO III级脑膜瘤患者PFS和OS的独立预后因素。作者还发现，更彻底地切除肿瘤，以及术后放射治疗，可能会延长患者的生存时间。
OBJECTIVE Malignant meningioma is rare and classified as Grade III in the WHO classification of CNS tumors. However, the presence of estrogen receptor (ER) in WHO Grade III meningiomas and its correlation with patients' outcomes are still unclear. In this single-center cohort study, the authors analyzed clinical features, treatment, and prognosis of these malignant tumors in patients with long-term follow-up.METHODS A total of 87 patients who were pathologically diagnosed with WHO Grade III meningiomas between 2003 and 2008 were enrolled in this study and followed for at least 7 years. Clinical information was collected to analyze the factors determining the prognosis.RESULTS Twelve patients with rhabdoid, 12 with papillary, and 63 with anaplastic meningioma were included. The mean progression-free survival (PFS) and overall survival (OS) were 56.2 +/- 49.8 months and 68.7 +/- 47.4 months, respectively. No significant differences were observed among the 3 histological subtypes in either PFS (p = 0.929) or OS (p = 0.688). Patients who received gross-total resection had a longer PFS (p = 0.001) and OS (p = 0.027) than those who received subtotal resection. Adjuvant radiotherapy was associated with OS (p = 0.034) but not PFS (p = 0.433). Compared with primary meningiomas, patients with recurrent disease had worse PFS (p < 0.001). For patients who had malignant transformations, the prognosis was poorer than for patients without malignant transformations for both PFS (p = 0.002) and OS (p = 0.019). ER-positive patients had a significantly worse prognosis than ER-negative patients regarding both PFS (p = 0.003) and OS (p < 0.001), whereas no association between progesterone receptor and patients' outcomes was observed. Multivariate analysis demonstrated that ER expression was an independent prognostic factor for both PFS (p = 0.008) and OS (p < 0.001).CONCLUSIONS This retrospective study showed that patients with meningioma with ER-positive expression had a much worse prognosis than those with ER weak-positive or ER-negative status. The results demonstrated that ER is an independent prognostic factor for both PFS and OS of patients with WHO Grade III meningioma. The authors also found that more radical resection of the tumor, as well as postoperative radiotherapy, may prolong patients' survival time.