脑膜瘤复发的多因素研究(英文)

目的探讨诸多临床因素和影像学特征对脑膜瘤复发的影响。以便能有效地早期预防和控制脑膜瘤复发,改善其预后。方法回顾1993～1997年武汉大学中南医院神经外科经手术治疗脑膜瘤患者145例,对其临床诊治过程和影像学资料进行回顾性分析,发现其中资料齐全的有83例,分析其临床因素如性别、年龄、手术切除程度、组织学类型和影像学特征如瘤周水肿、肿瘤形状、肿瘤大小、骨质改变、肿瘤部位、钙化、瘤周边界、CT 增强形态。应用 SPSS 11.07软件,进行单因素分析和多因素分析。多因素分析应用二值多元 logic 回归模型,以诸多临床因素和影像学特征作为自变量,复发与否作为因变量。结果经单因素分析显示:肿瘤形状、肿瘤大小、瘤周水肿、组织学类型,手术切除程度、肿瘤部位和 CT 增强形态与脑膜瘤复发有明显关系。多因素分析显示:肿瘤形状、肿瘤大小、肿瘤部位、瘤周水肿、组织学类型、手术切除程度、CT 增强形态是影响脑膜瘤复发的主要因素。其它因素在单因素分析及多因素分析中均显示对脑膜瘤复发无明显影响。结论脑膜瘤手术切除程度、组织学类型和 CT 扫描增强对脑膜瘤复发有明显影响。可作为预测脑膜瘤复发的显著危险因子和标准。     

脑膜瘤复发的影像学、临床因素探讨

目的:分析影像学特征和临床因素对脑膜瘤复发的影响.方法:对1992年1月～2000年1月本院神经外科经手术治疗脑膜瘤患者166例进行回顾性分析,应用SPSS11.07通过卡方检验进行单因素分析,应用二值多元Logic回归模型,以影像学和临床指标作为自变量,复发与否作为因变量作多因素分析.结果:单因素分析:肿瘤部位、肿瘤大小、肿瘤形状、瘤周水肿、组织学类型,手术切除程度、CT增强形态与脑膜瘤复发有明显关系,有显著性差异.多因素分析:肿瘤部位、肿瘤形状、手术切除程度、组织学类型、CT增强形态是影响脑膜瘤复发的主要因素,有显著性差异.结论:肿瘤部位、肿瘤形状、手术切除程度、组织学类型和CT扫描增强对脑膜瘤复发有明显影响.     

脑膜瘤复发的临床、影像学因素分析

目的　探讨诸多临床因素和影像学特征对脑膜瘤复发的影响。方法　对 1993～ 1997年武汉大学中南医院神经外科经手术治疗脑膜瘤患者 14 5例进行回顾性分析 ,其中资料齐全的有 83例 ,应用SPSS11.0 7软件通过卡方检验进行单因素分析 ,应用二值多元Logic回归模型 ,以临床和影像学指标作为自变量 ,复发与否作为因变量作多因素分析。结果　单因素分析 :肿瘤形状、肿瘤大小、瘤周水肿、组织学类型 ,手术切除程度、肿瘤部位和CT增强形态与脑膜瘤复发有明显关系 ,有显著性差异。多因素分析 :肿瘤形状、肿瘤部位、组织学类型、手术切除程度、CT增强形态是影响脑膜瘤复发的主要因素 ,有显著性差异。结论　肿瘤形状、肿瘤部位、手术切除程度、组织学类型和CT扫描增强对脑膜瘤复发有明显影响。     

影像学特征与脑膜瘤复发的相关性研究

目的探讨影像学特征对脑膜瘤复发的相关性.以便能有效地早期预防和控制脑膜瘤复发,改善其预后.方法收集1993～1997年武汉大学中南医院神经外科经手术治疗脑膜瘤患者145例,对其影像学资料进行回顾性分析,发现其中资料齐全的有83例,分析影像学特征如瘤周水肿、肿瘤形状、肿瘤大小、骨质改变、肿瘤部位、钙化、瘤周边界、CT增强形态.应用SPSS11.07软件,进行单因素分析和多因素分析.多因素分析应用二值多元logistic回归模型,以影像学特征作为自变量,复发与否作为因变量.结果经单因素分析显示:肿瘤形状、肿瘤大小、瘤周水肿、肿瘤部位和CT增强形态与脑膜瘤复发有明显关系.多因素分析显示:肿瘤形状、肿瘤部位、CT增强形态是影像学因素中影响脑膜瘤复发的主要因素.其它因素在单因素分析及多因素分析中均显示对脑膜瘤复发无明显影响.结论肿瘤形状、肿瘤部位、CT扫描增强对脑膜瘤复发有明显影响.可作为预测脑膜瘤复发的显著危险因子和标准.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

脑膜瘤术后复发再次手术治疗九例

目的 探讨影响脑膜瘤复发的临床因素,以早预防和控制脑膜瘤复发.方法 回顾10年来收治的复发脑膜瘤患者9例.分析其临床因素(如临床表现、影像学表现、手术切除程度、肿瘤大小等)与脑膜瘤复发的关系.结果 肿瘤大小、瘤周水肿、手术切除程度(与窦粘连部分残留)与脑膜瘤复发有明显关系.结论 对有脑浸润或者瘤周脑水肿的脑膜肿瘤患者应适当增大手术切除范围,受侵蚀的骨质应尽量切除,以降低复发率.     

ANALYSIS OF VARIABLES AFFECTING SURVIVAL OF PATIENTS WITH ASTRACYTOMAS

Objective: To evaluate the factors that affect the survival of patients with astrocytomas. Methods: We reviewed the clinical and radiological features of 104 patients operated during 1995-2000. The features were evaluated with univariate and multivariate analysis.Results: Univariate statistical analysis revealed that tumor localization, enhancement, edema, tumor invasion, seizure as the first symptom recurrence, edema,tumor invasion, seizure as the first symptom and recurrence of astrocytomas significantly affected the survival, In multivariate analysis four factors showed significant danger to long survival: necrosis,pathological grade, Karnofsky Performance Scale (KPS)score before operation, extent of resection. The rest factors appeared to be of no benefit to survival.Conclusion: The important factors that affect the long survival of patients with astrocytomas are necrosis,pathological grade, KPS score before operation and extent of resection.     

WHOⅡ级脑膜瘤术后复发的相关性因素分析

目的:探讨WHOⅡ级脑膜瘤的手术治疗方式及影响患者术后复发的相关因素。方法:以我院2008年1月-2018年6月收治的103名WHOⅡ级的脑膜瘤患者为研究对象，103例WHOⅡ级脑膜瘤患者中9例采用肿瘤次全切（Simpson IV级），94例采用肿瘤全切术（Simpson I-III级）。103例患者术后复发31例，无复发72例。分析患者年龄、性别、脑膜瘤病理类型、瘤周水肿、肿瘤最大径、肿瘤切除程度及术后放疗等与肿瘤复发的关系。结果:单因素Cox回归分析显示，年龄、性别、肿瘤最大径与肿瘤病理类型对WHO Ⅱ级脑膜瘤术后复发影响较小（P＞0.05）。多因素Cox回归分析显示，伴有瘤周水肿、Simpson分级是影响WHO Ⅱ级脑膜瘤术后复发的独立危险因素（P＜0.05）。术后放疗是WHO Ⅱ级脑膜瘤术后复发的保护因素（P＜0.05）。结论:Simpson分级、有无瘤周水肿及术后是否放疗是影响WHO Ⅱ级脑膜瘤是否复发的相关因素。     

The Role of Pre-Operative MRI for Prediction of High-Grade Intracranial Meningioma: A Retrospective Study

Objective: High histological grade (WHO grade 2 and 3) intracranial meningiomas have been linked to a greater risk for tumor recurrence and worse clinical outcomes compared to low-grade (WHO grade 1) tumors. Preoperative magnetic resonance imaging (MRI) plays a crucial role in tumor evaluation and allows a better understanding of tumor grading, which could potentially alter clinical outcomes. The present study sought to determine whether preoperative MRI features of intracranial meningiomas can serve as predictors of high-grade tumors. Methods: This retrospective study reviewed 327 consecutive confirmed cases of intracranial meningiomas, among whom 210 (64.2%) had available preoperative MRI studies. Thereafter, imaging features such as intratumoral signal heterogeneity, venous sinus invasion, necrosis or hemorrhage, mass effect, cystic component, bone invasion, hyperostosis, spiculation, heterogeneous tumor enhancement, capsular enhancement, restricted diffusion, brain edema, and unclear tumor-brain interface were obtained and data were analyzed using univariate and multivariate analyses. Results: 249 (76.1%) patients had low-grade (grade I), and 78 (23.9%) had high-grade (grades 2 and 3) intracranial meningioma. The majority of cases were females (274 cases, 83.3%) and most patients were below 60 years of age (mean age, 52.50 ± 11.51 years). The multivariate analysis with Multiple Logistic regression analysis using factors determined to be significant during univariate analysis via a backward stepwise selection method with statistical significance set at 0.05 identified three MRI features including necrosis or hemorrhage (adjusted OR = 2.94, 95% CI: 1.15–7.48, p = 0.024), hyperostosis (adjusted OR = 0.31, 95% CI: 0.12–0.79, p = 0.014), and brain edema (adjusted OR = 2.33, 95% CI: 1.13–4.81, p = 0.022) as significant independent predictors of high-grade meningioma after adjusting for confounders. Conclusions: Our study suggested that certain preoperative MRI features of intracranial meningiomas including necrosis or hemorrhage and brain edema could potentially predict high-grade tumors while hyperostosis is a predictor for low-grade tumors.     

Malignant meningiomas: a retrospective study of 22 cases

Malignant (anaplastic) meningioma constitutes a rare subset of meningioma. The aim of the study was to study clinical features and management of malignant meningiomas. Twenty-two patients with malignant meningiomas were surgically treated in our department between January 1986 and January 2005 in Qilu hospital, and we reviewed each patient's clinical records, radiological findings, operative reports, and pathological examinations. Simpson grade I resection was achieved in 16 cases and grade II resection in 6 cases. Postoperative radiotherapy was performed in all patients. No death occurred during the perioperative period in this series. The follow-up period ranged from six months to ten years. Overall 5-year survival and recurrence-free survival estimates were 36.4 and 27.3%, respectively. 16 patients with Simpson Grade I resection had longer median survival times than 6 patients with Simpson Grade II resection (70 months compared with 10 months, p = 0.0001). Only tumor location (p = 0.016) and Simpson grade of surgical resection (p = 0.002) had an impact on outcome according to a Cox regression analysis. Surgical resection and adjuvant radiotherapy are the main treatments for malignant meningiomas, and the degree of tumor removal is the leading factor determining postoperative recurrence and survival.     

EGF signalling and rapamycin-mediated mTOR inhibition in glioblastoma multiforme evaluated by phospho-specific flow cytometry

Various degrees of peritumoral brain edema (PTBE) are observed in patients with intracranial meningiomas. Factors affecting the occurrence of PTBE in intracranial meningioma were investigated. PTBE was investigated retrospectively for 110 patients with primary intracranial meningiomas. Predictive factors related to PTBE were analyzed, for example patient age, sex, magnetic resonance imaging features (contrast enhancement, tumor shape, tumor location, tumor volume), angiographical features (tumor stain, pial–cortical arterial supply, venous obstruction), and histopathological features (histological subtypes, mindbomb homolog 1 labeling index (MIB1-LI)). Histological subtypes were classified into World Health Organization (WHO) grade I common type (meningothelial, transitional, fibrous), grade I uncommon type, and grade II and III types. The extent of PTBE was assessed by calculation of the edema index (EI). PTBE was present in 53 cases (48 %). Male sex, heterogeneous enhancement, superficial location, tumor volume (≥10 cm³), remarkable tumor stain, pial supply, venous obstruction, malignant pathology, and MIB1-LI ≥4 % were correlated with PTBE in univariate analysis. Pial supply and remarkable tumor stain were correlated with PTBE in multivariate analysis. WHO grade I uncommon type had obviously higher EI than WHO grade I common type, and WHO grade II and III types (P < 0.001). Seven cases with prominently high EI (EI ≥10) were all WHO grade I uncommon type, including angiomatous, microcystic, secretory, and lymphoplasmacyte-rich meningioma. Prominently extensive PTBE might indicate the presence of WHO grade I uncommon type meningioma.     

Prediction of high-grade meningioma by preoperative MRI assessment

High-grade (World Health Organization grades II and III) meningiomas grow aggressively and recur frequently, resulting in a poor prognosis. Assessment of tumor malignancy before treatment initiation is important. We attempted to determine predictive factors for high-grade meningioma on magnetic resonance (MR) imaging before surgery. We reviewed 65 meningiomas (39 cases, benign; 26 cases, high-grade) and assessed four factors: (1) tumor–brain interface (TBI) on T1-weighted imaging (T1WI), (2) capsular enhancement (CapE), i.e., the layer of the tumor–brain interface on gadolinium-enhanced T1WI (T1Gd), (3) heterogeneity on T1Gd, and (4) tumoral margin on T1Gd. All four factors were useful in distinguishing high-grade from benign meningiomas, according to univariate analysis. On multivariate regression analysis, unclear TBI and heterogeneous enhancement were independent predictive factors for high-grade meningioma. In meningiomas with an unclear TBI and heterogeneous enhancement, the probability of high-grade meningioma was 98%. Our data suggest that this combination of factors obtained from conventional sequences on MR imaging may be useful to predict high-grade meningioma.     

H3K27me3 loss indicates an increased risk of recurrence in the Tübingen meningioma cohort

BackgroundA loss of the trimethylation of lysine 27 of histone H3 (H3K27me3) in meningioma has been recently suggested as an adjunct to identify subsets of higher risk of recurrence. The aim of the present study was to assess the prognostic value of H3K27 histone trimethylation and its potential clinical utility in the “Tübingen meningioma cohort.”MethodsPatients who underwent meningioma resection between October 2003 and December 2015 at the University Hospital Tübingen were included. Immunohistochemical stainings for H3K27me3 and the proliferation marker MIB1 were assessed and correlated with clinical parameters using univariate and multivariate Cox regressions as well as Pearson''s chi-squared and log-rank test.ResultsOverall, 1268 meningiomas were analyzed with a female to male ratio of 2.6 and a mean age of 58.7 years (range 8.3–91.0). With 163 cases lost to follow up, 1103 cases were available for further analysis with a mean follow-up of 40.3 months (range 1.1–186.3). Male gender, younger age, intracranial tumor localization, progressive tumor, subtotal resection, higher WHO grade, increased MIB1 rate, and loss of H3K27me3 were significant negative prognostic factors in the univariate analysis. H3K27me3 status and all other prognostic factors, except age and tumor location, remained significant in the multivariate model. Furthermore, adjuvant radiotherapy was an independent positive prognostic factor.ConclusionsLoss of H3K27me3 combined with MIB1 labeling index are independent prognostic factors in meningioma. These data from the Tübingen meningioma cohort support the clinical utility of H3K27me3 immunohistochemical staining in meningioma and its integration into the routine histopathological workup.