Meta-analysis Of Factors Influencing Postoperative Recurrence Of Atypical Meningioma

Objective: To evaluate the predictive factors of postoperative recurrence in patients with atypical meningioma(AM)and provide a more reasonable basis for the subsequent treatment of AM.Methods: We searched the literatures related to postoperative recurrence of atypical meningioma from database establishment to February 2021 in the databases by computer,which included Pub Med,Embase,Cochrane Library,Web of Science and other foreign language databases as well as Chinese databases,such as China National Knowledge Infrastructure(CNKI)、Wan Fang、 VIP and China Biomedical Literature Service System.And the search results were imported into Endnote X9 for management.According to the established inclusion criteria and exclusion criteria,the study literature data that met the requirements were extracted,including the number of included patients,gender,age,preoperative KPS score,tumor location(located beside the sickle/sinus),tumor size,extent of surgical resection,bone invasion,mitotic index,MIB-1 proliferation index,brain invasion,tumor necrosis,postoperative adjuvant radiotherapy and follow-up time.N0 S was selected as the literature quality evaluation table to assess the quality of the included articles,and high-quality studies were selected for meta-analysis.The data were processed using Review Manager 5.4 software to draw a forest plot.Results: A total of 16 literatures were included for Meta-analysis.The results showed that gender(HR = 1.35;95% CI: 1.08-1.68;P = 0.007),preoperative KPS score(HR = 0.69;95% CI: 0.50-0.97;P = 0.03),tumor location(HR = 2.07;95% CI: 1.45-2.96;P < 0.0001),extent of surgical resection(HR = 1.82;95% CI: 1.36-2.44;P < 0.0001),MI(HR = 1.14;95%CI: 1.07-1.21;P < 0.0001),MIB-1 proliferation index(HR = 2.68;95% CI:1.88-3.82;P < 0.00001),brain infiltration(HR = 1.63;95% CI: 1.12-2.35;P =0.010),tumor necrosis(HR = 1.89;95% CI: 1.35-2.64;P = 0.0002)and postoperative adjuvant radiotherapy(HR = 0.46;95% CI: 0.34-0.62;P <0.0001)were the influencing factors of AM recurrence.Conclusion: The meta-analysis only preliminarily analyzed the correlation between some predictors and tumor recurrence,and we should consider more about the effect of tumor location,extent of surgical resection and MIB-1 proliferation index on the recurrence of atypical meningioma.there are still many challenges in the treatment of atypical meningioma,and with the development of molecular pathology,it is believed that it can provide new research directions for the recurrence and treatment of atypical meningioma.