LONG-TERM RECURRENCE RATES OF ATYPICAL MENINGIOMAS AFTER GROSS TOTAL RESECTION WITH OR WITHOUT POSTOPERATIVE ADJUVANT RADIATION
LONG-TERM RECURRENCE RATES OF ATYPICAL MENINGIOMAS AFTER GROSS TOTAL RESECTION WITH OR WITHOUT POSTOPERATIVE ADJUVANT RADIATION
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DOI：
10.1227/01.neu.0000330399.55586.63
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发表时间：
2009-01-01
期刊：
影响因子：
4.8
通讯作者：
Barker, Fred G., II
中科院分区：
文献类型：
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作者：
Aghi, Manish K.;Carter, Bob S.;Barker, Fred G., II
目的：非典型脑膜瘤（AM）患者通常在就诊时进行大体全切除（GTR），但随后的预后和最佳治疗仍不清楚。我们试图确定GTR后AM的长期复发率，沿着预测复发的因素，包括术后放疗。方法：我们对1993年至2004年在我们机构GTR后的108例AM进行了回顾性分析。复发的危险因素进行了分析，采用多变量考克斯regression.RESULTS：有600患者年的成像随访48名男性和60名女性。在108例肿瘤中，30例（28%）在GTR后3至144个月（平均36个月）复发。实际肿瘤复发率分别为7%（1年）、41%（5年）和48%（10年）。108例患者中，8例接受术后放疗，无复发（P = 0.1）。多变量分析包括年龄、性别、术后放疗、肿瘤位置、MIB-1标记指数和6个病理学定义的组织学特征，确定了复发预测因素：年龄较大（风险比，1.6/10年; P = 0.01）、片状（风险比，2.2; P = 0.025）和核仁突出（风险比，2.1; P = 0.034）。递归分区确定了一个子集，有丝分裂和突出的核仁，70%复发（n = 14）的男性。所有复发患者均接受放射治疗，30例患者中有22例接受了开颅手术（平均每例复发患者2.7次开颅手术;范围为1-7次开颅手术）。22例脑膜瘤再次切除后仅1例发生恶变。30例复发患者中，10例复发后平均7年（1-14年）死亡。大多数复发发生在切除术后5年内。复发导致每例患者多次再次手术，缩短了生存期。我们的发现表明术后立即放疗的患者复发率较低，应在更大的前瞻性系列研究中进行研究。
OBJECTIVE: Atypical meningioma (AM) patients often undergo gross total resection (GTR) at the time of presentation, but subsequent prognosis and optimal management remain unclear. We sought to define the long-term recurrence rate of AMs after GTR, along with factors predicting recurrence, including postoperative radiation.METHODS: We performed a retrospective review of 108 AMs after GTR at our institution from 1993 to 2004. Recurrence risk factors were analyzed using multivariate Cox regression.RESULTS: There were 600 patient-years of imaging follow-up on 48 men and 60 women. Of 108 tumours, 30 (28%) recurred 3 to 144 months after GTR (mean, 36 months). Actuarial tumor recurrence rates were 7% (1 year), 41% (5 years), and 48% (10 years). Of 108 patients, 8 received postoperative radiation without recurrence (P = 0.1). Multivariate analysis including age, sex, postoperative radiation, tumor location, MIB-1 labeling index, and 6 atypical-defining histological features identified recurrence-predicting factors: older age (hazard ratio, 1.6/decade; P = 0.01), sheeting (hazard ratio, 2.2; P = 0.025), and prominent nucleoli (hazard ratio, 2.1; P = 0.034). Recursive partitioning identified a subset, men with mitoses and prominent nucleoli, with 70% recurrence (n = 14). All patients with recurrences received radiation, and 22 of 30 patients underwent craniotomies (average, 2.7 craniotomies per patient with recurrence; range, 1-7 craniotomies). Only 1 of 22 re-resected meningiomas underwent malignant transformation. of 30 patients with recurrence, 10 experienced tumor-induced mortality an average of 7 years after recurrence (range, 1-14 years).CONCLUSION: After GTR without postoperative radiation, AMs have a high recurrence rate. Most recurrences occurred within 5 years after resection. Recurrences caused numerous reoperations per patient and shortened survival. Our finding suggesting lower recurrence rates in patients undergoing immediate postoperative radiation should be investigated in larger, prospective series.