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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 investigate the therapeutic effect of atypical meningioma and the related prognostic factors. Methods Retrospective analysis of 38 cases of atypical meningioma with complete clinical data and follow-up data were performed surgical resection, and with reference to the 2007 WHO classification of brain tumor pathological diagnosis of atypical meningioma diagnosis, including 14 males and 24 females Cases, aged 31 to 72 years old, the median age of 53.5 years old, preoperative KPS score 40 to 90 points, median KPS 80 points; 21 cases of meningioma, skull base meningioma in 5 cases, next to the falx and the sagittal sinus Meningioma 10, and other 2 cases; Simpson Ⅰ grade resection in 15 cases, Simpson Ⅱ grade resection in 9 cases, Simpson Ⅲ grade resection in 6 cases, Simpson Ⅳ grade resection in 8 cases; 3D-CRT radiotherapy in 12 cases, the prescription dose Dt 50 ~ 60 Gy Bit Dt 54 Gy. Kaplam-Meier survival analysis, log-rank for the difference test. Results As of April 2017, 38 patients were followed up for 16 to 108 months with a median follow-up time of 24.5 months. Six patients relapsed during the follow-up period and two died. The median overall progression-free survival time (PFS) was 66 months, (P = 0.023), age (age <50 years vs age> 50 years, P = 0.034), Simpson grade (P = Simpson grade I vs grade II to IV, P = 0.028), but not with KPS (KPS≥80 vs KPS <80, P = 0.338), location of the lesion (convex vs non-convex, Radiotherapy, P = 0.456). Conclusions The treatment of atypical meningiomas is still dominated by surgery. Female, age <50 years old, Simpson Ⅰ grade resection is a favorable factor to prolong PFS, but postoperative adjuvant radiotherapy did not improve PFS.