85例脑膜瘤患者术后临床结局和复发情况及其影响因素的分析

doi:10.19854/j.cnki.1008-2425.2022.04.0006

摘要/Abstract

摘要： 目的分析并探讨脑膜瘤患者术后临床结局和复发情况及其影响因素。方法回顾性分析从2018年1月至2021年2月于我院首次诊断为脑膜瘤的患者人口统计学、临床、肿瘤及围手术期资料。对患者进行平均22.4±9.6个月的电话或门诊随访,并根据随访时mRS评分将患者分为预后良好(0~3)与预后不佳(＞3)两个亚组。多因素logistic回归分析确定影响患者预后及复发的因素。结果 85名患者的平均年龄为46岁,女性与男性患者的比例为2:1,29例患者合并有既往病史。其中,83.5%的肿瘤位于幕上,82.4%的肿瘤＞5 cm,85.9%进行了肿瘤完全切除(SM I-III级),92.9%的肿瘤WHO病理分级为I级。随访结果提示,92.9%的患者预后良好,5.9%的患者肿瘤复发。多变量logistic回归分析显示,肿瘤<3 cm (OR=0.023,95% CI 0.001~0.518;P=0.009)、完全切除(OR=17.650,95% CI 4.761~61.026;P＜0.001)和既往病史(OR=0.205,95% CI 0.014~0.837;P=0.002)是影响预后的重要因素,而年龄(OR=3.534,95% CI 1.293~11.851;P=0.028)和WHO病理分级(OR=0.021,95%CI 0.001-0.324,P＜0.001)与肿瘤复发显著相关。结论大多数脑膜瘤患者预后良好,肿瘤大小、手术切除范围、年龄、肿瘤病理学分级和既往病史等与术后结局及复发显著相关。

关键词: 脑膜瘤, mRS, 预后, 复发

Abstract: Objective To analyze and investigate the postoperative clinical outcomes and recurrence of meningioma patients and their influencing factors.Methods Demographic,clinical,oncologic,and perioperative data of patients first diagnosed with meningioma at our hospital from January 2018 to February 2021 were retrospectively analyzed.Patients were followed up for a mean of 22.4 ± 9.6 months by telephone or outpatient,and patients were divided into two subgroups of good prognosis (0~3) and poor prognosis (>3) according to their mRS scores at follow-up.Multivariate logistic regression analysis was performed to determine the factors affecting the prognosis and recurrence of patients.Results The mean age of the 85 patients was 47 years,the ratio of female to male patients was 2:1,and 29 patients had a combined prior medical history.Among them,83.5% of the tumors were located in the supratentorial,82.4% of the tumors were >5 cm,85.9% underwent gross total resection (SM grade I-III),and 92.9% of the tumors were WHO pathologically graded as grade I.The follow-up results suggested that 92.9% of patients had a good prognosis and 5.9% of patients had recurrence.Multivariate logistic regression analysis showed that tumors <3 cm (OR=0.023,95% CI 0.001~0.518;P=0.009),gross total resection (OR=17.650,95% CI 4.761~61.026;P＜0.001) and medical comorbidities (OR=0.205,95% CI 0.014~0.837;P=0.002) were significant factors affecting prognosis,while age (OR=3.534,95% CI 1.293~11.851;P=0.028) and WHO pathological classification (OR=0.021,95% CI 0.001~0.324,P＜0.001) were significantly associated with tumor recurrence.Conclusion Most patients with meningioma had a good prognosis,and tumor size,extent of resection,age,tumor pathologic grade,and medical comorbidities were significantly associated with postoperative outcome and recurrence.

Key words: Meningioma, mRS, Prognosis, Recurrence

中图分类号:

R739.45

韩世文，洪文明，宣浩. 85例脑膜瘤患者术后临床结局和复发情况及其影响因素的分析[J]. 立体定向和功能性神经外科杂志, 2022, 35(4): 221-225.

Han Shiwen,Hong Wenming,Xuan Hao.. Risk factors for postoperative clinical outcomes and recurrence of 85 meningioma patients[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(4): 221-225.

参考文献

[1] Zhang J,Yao K,Liu P,et al.A radiomics model for preoperative prediction of brain invasion in meningioma non-invasively based on MRI:a multicentre study[J].EbioMedicine,2020,58:102933.
[2] Ostrom QT,Cioffi G,Gittleman H,et al.CBTRUS Statistical Report:Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2012-2016[J].Neuro Oncol.2019,21(5):v1-v100.
[3] Louis DN,Perry A,Reifenberger G,et al.The 2016 World Health Organization Classification of Tumors of the Central Nervous System:a summary[J].Acta Neuropathol.2016,131(6):803~820.
[4] 杨启荣,胡智洪,李伟,等.良性脑膜瘤术后早期复发相关危险因素的Logistic回归分析[J].肿瘤预防与治疗,2022,35(03):250~254.
[5] 祝斐,颉奎,饶敏,等.良性脑膜瘤术后复发的影响因素分析[J].中国临床神经外科杂志,2015,20(2):90~92.
[6] Laeke T,Biluts H,Sahlu A.Clinical Outcome of Operated Intracranial Meningiomas:An Ethiopian Experience[J].World Neurosurg,2019,128:e81~e86.
[7] Corell A,Thurin E,Skoglund T,et al.Neurosurgical treatment and outcome patterns of meningioma in Sweden:a nationwide registry-based study[J].Acta Neurochir (Wien),2019,161(2):333~341.
[8] Lemée JM,Corniola MV,Da Broi M,et al.Early postoperative complications in meningioma:predictive factors and impact on outcome[J].World Neurosurg,2019,128:e851~e858.
[9] Sankila R,Kallio M,Jskelinen J,et al.Long-term survival of 1986 patients with intracranial meningioma diagnosed from 1953 to 1984 in Finland[J].Cancer,1992,70(6):1568~1576.
[10]Talbck M,Stenbeck M,Rosén M.Up-to-date long-term survival of cancer patients:an evaluation of period analysis on Swedish Cancer Registry data[J].Eur J Cancer,2004,40(9):1361~1372.
[11]Stafford SL,Perry A,Suman VJ,et al.Primarily resected meningiomas:outcome and prognostic factors in 581 Mayo Clinic patients,1978 through 1988[J].Mayo Clin Proc,1998,73(10):936~942.
[12]McCarthy BJ,Davis FG,Freels S,et al.Factors associated with survival in patients with meningioma[J].J Neurosurg,1998,88(5):831~839.
[13]Nanda A,Bir SC,Maiti TK,et al.Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma[J].J Neurosurg,2017,126(1):201~211.
[14]Oya S,Kawai K,Nakatomi H,et al.Significance of Simpson grading system in modern meningioma surgery:integration of the grade with MIB-1 labeling index as a key to predict the recurrence of WHO Grade I meningiomas[J].J Neurosurg,2012,117(1):121~128.
[15]Aizer AA,Bi WL,Kandola MS,et al.Extent of resection and overall survival for patients with atypical and malignant meningioma[J].Cancer,2015,121(24):4376~4381.
[16]Mubeen B,Makhdoomi R,Nayil K,et al.Clinicopathological characteristics of meningiomas:experience from a tertiary care hospital in the Kashmir Valley[J].Asian J Neurosurg,2019,14(1):41~46.
[17]Spille DC,Hess K,Bormann E,et al.Risk of tumor recurrence in intracranial meningiomas:comparative analyses of the predictive value of the postoperative tumor volume and the Simpson classification[J].J Neurosurg,2020,134(6):1764~1771.
[18]Sahm F,Schrimpf D,Stichel D,et al.DNA methylation-based classification and grading system for meningioma:a multicentre,retrospective analysis[J].Lancet Oncol,2017,18(5):682~694.
[19]Hwang WL,Marciscano AE,Niemierko A,et al.Imaging and extent of surgical resection predict risk of meningioma recurrence better than WHO histopathological grade[J].Neuro Oncol,2016,18(6):863~872.