良性脑膜瘤术后复发的相关因素及预后分析  

Analysis of related factors and prognosis of postoperative recurrence of benign meningioma

作　　者：杨长志 马媛媛 杨云云 步昊 史梦乐 路洋 朱玉辐 YANG Chang-zhi;MA Yuan-yuan;YANG Yun-yun;BU Hao;SHI Meng-le;LU Yang;ZHU Yu-fu(Graduate School of Xuzhou Medical University,Xuzhou Jiangsu 221000,China;Department of Neurosurgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221000,China)

机构地区：[1]徐州医科大学研究生院,江苏徐州221000 [2]徐州医科大学附属医院神经外科,江苏徐州221000

出　　处：《局解手术学杂志》2020年第10期827-831,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：江苏省科技厅社会发展项目(BE2016646)。

摘　　要：目的探讨良性脑膜瘤患者术后复发的危险因素及对其预后的影响。方法收集2015年4月至2019年4月于徐州医科大学附属医院神经外科接受手术治疗的915例良性脑膜瘤患者的临床资料,所有患者术后门诊或电话随访1年,根据术后1年内脑膜瘤复发情况将其分为复发组(n=44)和未复发组(n=871)。进行单因素分析和多因素Logistic分析,筛选对患者复发有统计学意义的因素。结果单因素分析结果显示,年龄、肿瘤部位、肿瘤最大直径、肿瘤形状、瘤周水肿情况、肿瘤切除程度、Ki-67表达情况、FASN表达情况、PCNA表达情况是影响良性脑膜瘤术后复发的相关因素(P<0.05)。多因素Logistic分析结果显示,年龄>57岁、肿瘤侵犯静脉窦及大脑镰旁、部分切除及Ki-67表达≥8%是脑膜瘤术后复发的独立危险因素(P<0.05)。结论肿瘤侵犯静脉窦及大脑镰旁、边界不清、部分切除、年龄>57岁、Ki-67表达≥8%的良性脑膜瘤患者术后复发风险更高。临床治疗时应尽可能完全切除,即使对于病理诊断为WHOⅠ级的脑膜瘤患者,也应进一步做免疫组化检测,Ki-67表达情况,以评估预后。Objective To explore the risk factors of postoperative recurrence in patients with benign meningioma and its impact on prognosis.Methods The clinical data of 915 patients with benign meningioma who received surgical treatment in the neurosurgery department of Affiliated Hospital of Xuzhou Medical University from April 2015 to April 2019 were collected.All the patients were followed up for 1 year by outpatient or telephone.According to the recurrence of meningioma within 1 year after operation,they were divided into the recurrence group(n=44)and the non-recurrence group(n=871).Univariate analysis and multivariate Logistic analysis were used to screen the factors that had statistical significance for recurrence.Results Univariate analysis showed that the age,tumor location,tumor maximum diameter,shape of tumor,peritumoral edema,degree of tumor resection,expression of Ki-67,FASN and PCNA were the related factors influencing postoperative recurrence of benign meningioma(P<0.05).Multivariate Logistic analysis showed that the age>57 years old,tumor invasion of venous sinus and cerebral falx,partial resection and Ki-67 expression≥8%were independent risk factors for postoperative recurrence of meningioma(P<0.05).Conclusion Patients of benign meningioma with tumor invasion of venous sinus and cerebral falx,unclear boundary,partial resection,age>57 years old and Ki-67 expression≥8%have higher risk of postoperative recurrence.In clinical treatment,complete resection should be performed as much as possible during operation.Even for patients with meningioma whose pathological diagnosis is WHOⅠgrade,further immunohistochemistry Ki-67 should be performed to observe its expression value,so as to assess the prognosis.

关 键 词：脑膜瘤 复发 Simpson分级切除 KI-67 危险因素 预后 颅内肿瘤 

分 类 号：R739.41[医药卫生—肿瘤]