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目的探讨脑膜瘤手术切除后的复发因素。方法回顾分析沈阳军区总医院和上海长征医院神经外科162例手术显微镜下切除的位于静脉窦旁、镰旁、以及一些颅底脑膜瘤患者临床资料,排除凸面脑膜瘤,随访3～5年,应用单因素、多因素分析Cox模型统计学方法,分析脑膜瘤的临床特征(性别、年龄、肿瘤大小、形状)、病理分级、免疫组化指标[包括肿瘤增殖标志物Ki-67,雄激素受体(AR)、雌激素受体(ER)、孕激素受体(PR)]的表达与复发的关系。结果 53例脑膜瘤复发(复发率32.7%)。免疫组化染色结果提示AR、ER、PR、Ki-67抗体在部分脑膜瘤标本细胞核中呈阳性表达。Cox模型显示肿瘤大小、形状、病理级别和Ki67的表达与复发相关(P<0.05)。结论脑膜瘤显微镜下切除后5年内复发率较高。体积较大、不规则形态、病理Ⅱ级和Ⅲ级、Ki67表达阳性是复发的危险因素,随访时间延长复发率有增高趋势。
Objective To investigate the recurrence of meningiomas after surgical resection. Methods A retrospective analysis of 162 cases of neurosurgery at Shenyang General Hospital of Stomatology and Shanghai Changzheng Hospital, which were excised under the operation microscope, was performed in patients with paravalvular sinus, falx, and some skull base meningiomas. The patients were followed up for 3 to 5 years. Univariate and multivariate Cox model was used to analyze the clinical features (gender, age, tumor size, shape) of meningioma, pathological grade, immunohistochemistry index [including tumor proliferation marker Ki-67, androgen receptor (AR), estrogen receptor (ER), progesterone receptor (PR)] expression and relapse. Results 53 cases of meningioma recurrence (recurrence rate was 32.7%). The results of immunohistochemistry suggested that the AR, ER, PR and Ki-67 antibodies were positive in the nuclei of some meningiomas. The Cox model showed that tumor size, shape, pathological grade and Ki67 expression were associated with recurrence (P <0.05). Conclusions Meningiomas have a high recurrence rate within 5 years after resection. Larger, irregular morphology, pathological grade Ⅱ and Ⅲ, Ki67 positive expression of risk factors for recurrence, follow-up time prolonging the recurrence rate increases.