非典型脑膜瘤38例疗效及预后因素分析

摘要

目的 探讨非典型脑膜瘤治疗疗效及影响预后相关因素.方法 回顾性分析38例非典型脑膜瘤患完整的临床资料及随访资料,均行外科切除术,并参照2007年WHO脑肿瘤分类中非典型脑膜瘤病理诊断标准确诊,其中男14例,女24例,年龄31~72岁,中位年龄53.5岁,手术前KPS评分40~90分,中位KPS 80分;凸面脑膜瘤21例,颅底脑膜瘤5例,大脑镰旁和矢状窦旁脑膜瘤10,其他2例;SimpsonⅠ级切除15例,SimpsonⅡ级切除9例,SimpsonⅢ级切除6例,SimpsonⅣ级切除8例;术后行3D-CRT放疗12例,处方剂量Dt 50~60 Gy中位Dt 54 Gy.采用Kaplam-Meier进行生存分析,log-rank进行差异性检验.结果 截至2017年4月,38例患者随访16~108个月,中位随访时间24.5个月,随访期间6例复发,2例死亡;全组中位无进展生存时间(PFS)66个月,5年PFS 53.3%,5年OS 80.0%;单因素分析结果患者PFS与性别(女vs男,P=0.023)、年龄(年龄<50岁vs年龄≥50岁,P=0.034)、Simpson分级(SimpsonⅠ级vsⅡ~Ⅳ级,P=0.028)相关,而与KPS(KPS≥80 vs KPS<80,P=0.338)、病灶位置(凸面vs非凸面,P=0.201)、术后放疗(放疗vs非放疗,P=0.456)无关.结论 非典型脑膜瘤治疗依然以外科手术为主,女性、年龄<50岁、SimpsonⅠ级切除为延长PFS有利因素,但术后辅助放疗并未改善PFS.%Objective To assess the prognosis and potential predictable factors for patients with atypical meningi -omas ( AMs) .Methods A total of 38 patients with AMs were retrospective analyzed .All the tumors were underwent surgical resection and were pathologically confirmed .Fourteen of them were males with a median age of 53.5 years (range, 31-72 years).And 21 cases were convex meningiomas, 5 were basal skull meningiomas.Simpson grade Ⅰ,Ⅱ,Ⅲ, andⅣresection were achieved in 15, 9, 6, and 8 cases, respectively.Three-dimensional conformal radiation therapy was applied in 12 cases postoperatively, with a median Dt of 54Gy (50-60Gy).Results The median follow-up time was 24.5 months (range, 16~108 months).Six patients relapsed and 2 died at the last follow-up.The median progression-free survival (PFS) was 66 months, 5 -year PFS`and 5 -year overall survival (OS) were 53.3% and 80.0%, respectively.In univariate analysis, sex (P=0.023), age (P=0.034) and Simpson grade (P=0.028) were significantly correlated with PFS .Conclusion Surgical resection remains the main method to treat AMs .Female, younger age and Simpson I resection were associated with favorable prognosis .However , postoperative adjuvant radiotherapy did not improve PFS .The conclusions of the present study warranted further research to confirm .