中枢神经系统孤立性纤维瘤临床特征及术后复发因素  

Clinical features and recurrent factors of solitary fibrous tumor in central nervous system

作　　者：吴虹林 苏伟杰 李西西 高辛亚 杨李轩[1] WU Honglin;SU Weijie;LI Xixi;GAO Xinya;YANG Lixuan(Department of Neurosurgery,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院神经外科,广州510080

出　　处：《中国神经精神疾病杂志》2023年第2期85-91,共7页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金(编号:82073049)。

摘　　要：目的 以2021年6月世界卫生组织(World Health Organization,WHO)中枢神经系统肿瘤分类为基础,对中枢神经系统孤立性纤维瘤(solitary fibrous tumor,SFT)进行临床分析,并探讨肿瘤术后复发的相关因素。方法回顾我院近10年来诊治的SFT患者,分析其临床特征、治疗方式以及随访预后情况。以术后复发为结局,采用t检验和Fisher检验进行复发单因素分析,运用Cox回归模型进行多因素分析,再用Kaplan-Meier法绘制无复发生存期(recurrence-free survival,RFS)曲线,并采用log-rank法对RFS曲线进行比较。结果31例患者中,男20例,女11例,平均年龄46.9岁,肿瘤平均直径5.1 cm,其中幕上12例,幕下19例。临床表现主要为肿瘤压迫导致的头晕、头痛、神经功能缺损等症状。WHO分级Ⅰ级4例,Ⅱ级10例,Ⅲ级17例,Ki-67增殖指数平均为10%。肿瘤全切除21例,部分切除10例;术后放疗17例;术后复发12例;远处转移4例。核分裂相(P=0.042)和切除程度(P=0.002)是SFT术后复发重要因素;Cox多因素分析显示肿瘤切除程度(P=0.014)和WHO分级(P=0.025)与患者RFS显著负相关。结论 中枢神经系统SFT十分少见,临床表现无特异性,确诊该病以术后病理诊断为准。SFT术后复发与肿瘤核分裂象和手术切除范围密切相关。手术切除范围和肿瘤分级可能和患者的预后不良有关。Objective The 2016 World Health Organization Classification of Central Nervous System(CNS)Tumors collectively referred to the mixed term solitary fibrous tumor/hemangiopericytoma(SFT/HPC)as SFT.This study sought to analyze the clinical characteristics,treatment methods and follow-up prognosis of SFT patients,and to investigate the potential risk factors associated with tumor recurrence after surgery.Methods We retrospectively reviewed SFT patients diagnosed and treated in our hospital in the past 10 years,and conducted univariate and multivariate analyses.RFS(recurrence free survival)curves were plotted by Kaplan-Meier method,and the RFS curves were compared by logrank method.Results Among the 31 patients,there were 20 males and 11 females,with an average age of 46.9 years and an average tumor diameter of 5.1 cm.The tumors were located in the supratentorial area in 12 cases,and in the infratentorial area in 19 cases.The main clinical manifestations were dizziness,headache,neurological deficit and other symptoms caused by tumor compression.According to the WHO classification,the tumors were graded as grade I in 4 cases,grade II in 10 cases,and grade III in 17 cases.The Ki-67 proliferation index was 10%on average.Twenty-one patients underwent complete tumor resection,and 10 underwent partial tumor resection.Postoperative radiotherapy was administered in 17 cases,and postoperative recurrence occurred in 12 cases,with tumor metastasis occurring in 4 cases.The mitotic phase(P=0.042)and the degree of excision(P=0.002)had statistical significance with the recurrence of SFT.Cox multivariate analysis showed that the degree of tumor resection(P=0.014)and tumor grade(P=0.025)were negatively correlated with patients'RFS.Conclusions SFT is very rare in central nervous system,clinical manifestations are not specific,the diagnosis of this disease is based on postoperative pathological diagnosis.The recurrence of SFT after surgery is closely related to the tumor's mitotic phase and the scope of surgical resection.The scope of su

关 键 词：孤立性纤维瘤 临床特征 手术 复发 危险因素 

分 类 号：R651[医药卫生—外科学]