非典型脑膜瘤的临床分析

摘要

目的：探讨非典型脑膜瘤的诊断、治疗及预后相关影响因素。方法回顾性分析2001～2011年首都医科大学附属北京天坛医院收治的89例经病理证实的非典型脑膜瘤，应用Log-rank法和Cox回归进行统计分析，并结合文献对本病的特点、治疗方法和预后进行分析。结果89例非典型脑膜瘤中72例肿瘤全切除，40例术后行放疗；中位PFS 72．6个月（2～102个月），2年、5年PFS率为74．5％、67．5％，OS率为93．6％、89．1％。单因素分析显示，继发肿瘤、女性、肢体瘫痪、KPS＜80的非典型脑膜瘤患者复发的风险增加（均P＜0．05）。多因素分析显示，继发肿瘤、肢体瘫痪患者的复发风险增加（均P＜0．05），KPS≥80患者有更长的存活时间（P＜0．05）。结论手术全切除是改善非典型脑膜瘤患者预后的重要手段；对未全切除者，术后推荐放疗。对于全切除的非典型脑膜瘤，首发症状为偏瘫、继发肿瘤、肿瘤存在骨侵袭、肿瘤存在脑侵袭。核有丝分裂象高、MIB-1指数高的患者为高危患者，存在这些危险因素中1项及以上者，推荐术后放疗。%Objective To investigate the diagnosis , treatment and prognostic factors of atypical meningiomas .Methods The clinical data of 89 patients with atypical meningioma who were treated at Beijing Tiantan Hospital Affiliated to Capital Medical University from 2001 to 2011 were analyzed retrospectively .Statistics were calculated using the log-rank method and Cox proportional hazards model , and reviewing related literatures to analyze the characteristics , treatment and prognosis of the disease .Results Among 89 atypical meningiomas , total resection was achieved in 40 patients.40 patients underwent radiotherapy after surgery .The median progression-free survival (PFS) was 72.6 month.(2-102 months) .The progression-free survival rate and overall survival rate of 2 year and 5 year were 74.5%,67.5% and 93.6%,89.1% respectively.On univariate analyses, secondary tumor,female,paresis and KPS score less than 80 will increase the risk of recurrence(P<0.05).On multivariate analyses, secondary tumor,paresis will increase the risk of recurrence ( P <0 .05 ) .KPS score more than 80 was a beneficial factor for OS ( P <0 .05 ) . Conclusions Total resection is the main procedure to improve the prognosis of atypical meningioma . Patients should receive radiotherapy after partial resection .For total resection , patients who existed the following factors were regarded as high-risk patients:initial symptoms for hemiplegia , secondary tumor,bone invasion,brain tissue invasion,high nuclear mitosis, higher MIB-1 index.Postoperative radiotherapy is recommended for patients with one or more facors mentinoned above .