Prognostic factors for progression in atypical meningioma
Prognostic factors for progression in atypical meningioma
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DOI：
10.3171/2017.6.jns17120
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发表时间：
2018-11-01
影响因子：
4.1
通讯作者：
Guiot, Marie-Christine
中科院分区：
文献类型：
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作者：
Shakir, Shakir I.;Souhami, Luis;Guiot, Marie-Christine
目的非典型脑膜瘤的最佳辅助治疗仍存在争议。本研究的目的是审查长期的结果，以确定潜在的预后因素疾病progress.METHODS从1992年8月至2013年8月，70例非典型脑膜瘤患者在作者的机构进行了治疗。根据WHO 2007标准进行病理学修订。患有多发性肿瘤、2型神经纤维瘤病或影像学随访不充分的患者不合格。作者通过MRI对肿瘤体积进行了术前和术后系列测量。年龄、性别、肿瘤位置、骨受累、脑浸润、核分裂像、术前疾病体积、切除范围、肿瘤生长率、辅助术后放疗（PORT）的使用，通过单变量和多变量分析评估放射治疗（RT）时的肿瘤体积和残留肿瘤体积，以确定其对疾病进展的潜在影响。全切除（GTR）30例，次全切除（STR）30例（43%）。12名GTR患者（30%）接受了PORT治疗，仅4名STR患者（13%）接受了PORT治疗。GTR组中有或无PORT患者的5年无进展生存率（PFS）分别为100%和54.1%（p = 0.0058）。STR组中有或无PORT患者的PFS分别为75%和0%（p = 0.0026）。在多变量分析中，STR和PORT是疾病进展的唯一独立显著预后因素，风险比分别为5.4873（95%CI 2.19-13.72，p = 0.0003）和0.0464（95%CI 0.0059-0.364，p = 0.0035）。根据Youden指数统计，RT时临界残留肿瘤体积大于8.76 cm 3与PFS较差相关（13.6% vs 56%，p = 0.0079）。在接受RT之前，患者的中位相对和绝对生长率以及肿瘤倍增时间分别为124.2%/年、4.8 cm 3/年和1.67年。这些指标在放疗后分别变为0.245%/年、-0.09 cm 3/年和-0.005年（p < 0.05）。结论：在非典型脑膜瘤中，即使在接受GTR的患者中，PORT的使用也与PFS的改善相关。残留肿瘤体积大于8.76 cm 3的患者疾病进展风险增加，应考虑早期RT。
OBJECTIVE The optimal adjuvant management for atypical meningiomas remains controversial. The aim of this study was to review long-term outcomes to identify potential prognostic factors for disease progression.METHODS From August 1992 to August 2013, 70 patients with atypical meningioma were treated at the authors' institution. Pathology revision was performed based on WHO 2007 criteria. Patients with multiple tumors, neurofibromatosis Type 2, or inadequate imaging follow-up were not eligible. The authors performed pre-and postoperative serial measurements of tumor volume from MRI. Age, sex, tumor location, bone involvement, brain invasion, mitotic figures, preoperative disease volume, extent of resection, tumor growth rates, use of adjuvant postoperative radiation therapy (PORT), and residual tumor volume at the time of radiation therapy (RT) were assessed by univariate and multivariate analysis to determine their potential impact on disease progression.RESULTS Forty patients (57%) underwent gross-total resection (GTR) and 30 (43%) underwent subtotal resection (STR). PORT was delivered to 12 patients (30%) with a GTR and in only 4 (13%) with an STR. The 5-year progressionfree survival (PFS) rate for patients in the GTR group with or without PORT was 100% and 54.1%, respectively (p = 0.0058). PFS for patients in the STR group with or without PORT was 75% and 0%, respectively (p = 0.0026). On multivariate analysis, STR and PORT were the only independent significant prognostic factors for disease progression with hazard ratios of 5.4873 (95% CI 2.19-13.72, p = 0.0003) and 0.0464 (95% CI 0.0059-0.364, p = 0.0035), respectively. Based on Youden's index statistic, a cutoff residual tumor volume of more than 8.76 cm3 at the time of RT was associated with worse PFS (13.6% vs 56%, p = 0.0079). Before receiving RT, the median relative and absolute growth rates and tumor doubling time for patients were 124.2%/year, 4.8 cm3/year, and 1.67 years, respectively. These indices changed after RT to 0.245%/year, -0.09 cm3/year, and -0.005 year, respectively (p < 0.05).CONCLUSIONS In atypical meningioma, the use of PORT is associated with improved PFS even in patients who undergo GTR. Patients with residual tumor volume larger than 8.76 cm3 have an increased risk of disease progression and should be considered for early RT.