| Part 1 Meta-analysis of effectiveness of postoperative adjuvant radiotherapy in atypical meningioma patients after gross total resectionObjectiveMeningiomas are one of the most common primary intracranial tumors.GradeⅡ(atypical)meningioma,alThe tumor site(frontal lobe)and tumor size are predictive factors for postoperative though has lower incidence than grade I(benign)meningioma,has greater aggressive behavior,higher risk of recurrence,and higher mortality.Therefore,it is especially important to establish an effective postoperative management model for atypical meningioma patients(AMs).And postoperative adjuvant radiotherapy(PORT)seems to be a reasonable choice,but the effectiveness is controversial.So we aim to explore the effectiveness of PORT through meta-analysis of relevant literature and hope it to guide the choice of postoperative radiotherapy.MethodsA systematic review of the literature on the relationship between PORT in AMs after GTR and patients’ prognosis between January 2007 and January 2019 in the Pubmed,Embase,Web of science and Scopus databases was performed.After a selection based on a certain exclusion criteria,then for the included literature,the NOS evaluation scale was used to evaluate the quality of the literature.Finally,meta-analysis was used to analyse the effects of PORT on recurrence rate,recurrence-free survival(RFS),progression-free survival(PFS)and overall survival(OS)in AMs after GTR,while comparing sensitivity and publication bias.Results:A total of 2144 AMs with 1542 AMs underwent GTR and 415 AMs underwent GTR+PORT in 19 articles were included in the meta-analysis.Meta-analysis of the relevant data revealed that PORT in AMs after GTR had a significant effect in overall recurrence rate(OR[95%Cl]=0.56[0.35-0.91],P=0.02)and 5-year RFS rate(OR[95%Cl]=2.50[1.19-5.23],P=0.02),but no significant association with 5-year OS rate(OR[95%Cl]=1.09[0.61-1.95],P=0.76).Maybe PORT had a trend to improve 5-year PFS rate,but there is no significant difference(OR[95%Cl]=1.58[0.99-2.53],P=0.06).Conclusion:Adjuvant radiotherapy can significantly reduce the recurrence rate in atypical meningioma patients after gross total resection,but it does not reduce the mortality.It may improve progression-free survival,but more large-sample,randomized,prospective studies are needed to confirm.Part 2 Effectiveness of postoperative adjuvant radiotherapy in atypical meningioma patientsObjective:The development of the new 2016 WHO grading standard for meningioma treats brain invasion as one of the criteria for atypical meningioma,resulting in a significant increase in the proportion of atypical meningiomas.But whether postoperative adjuvant radiotherapy(PORT)is effective in atypical meningioma patients(AMs)after gross total resection(GTR)is still controversial.Although the partial validity of PORT has been previously demonstrated by meta-analysis of previous relevant literature,it lacks Chinese data and whether to improve PFS requires further research.So we aim to perform this retrospective study to assess the effect of PORT on recurrence-free survival,progression-free survival(PFS)and overall survival(OS).At the same time,we also want to explore factors that may influence the clinical progression and prognosis of AMs.Methods:Patients who were diagnosed as atypical meningioma by pathological examination were collected from March 2013 to June 2016 in the neurosurgery department at the Second Affiliated Hospital of Zhejiang University School of Medicine.At the same time,collecting the following data for each patient who met the inclusion criteria:baseline data,image data and follow-up data.Comparing the effects of PORT on RFS,PFS and OS in all postoperative patients,patients after gross-total resection(GTR),and patients after subtotal resection(STR).Results:A total of 145 AMs were enrolled.Univariate COX regression analysis showed that compared with AMs after STR,AMs after GTR had longer RFS(P<0.001)and PFS(P<0.001),but no longer OS(P=0.543).PORT can not improve RFS(P=0.637),PFS(P=0.352)or OS(P=0.064).Intratumoral spontaneous necrosis had reduced trends in RFS(P=0.108),PFS(P=0.058)and OS(P=0.076).Multivariate COX regression analysis showed that STR was an independent risk factor for recurrence(HR[95%Cl]=0.13[0.05-0.38],P<0.001)and progression(HR[95%Cl]=0.19[0.08-0.47],P<0.001).Old people(HR[95%Cl]=1.08[1.01-1.15],P=0.031),intratumoral spontaneous necrosis(HR[95%Cl]=6.63[1.56-28.23],P=0.010)and PORT(HR[95%Cl]=9.07[1.82-45.14],P=0.007)were independent risk factors for death.Kaplan-Meier survival curves and log-rank test showed that GTR surgery could significantly improve RFS(P<0.0001)and PFS(P<0.0001),but not OS(P=0.540).PORT could not improve RFS(P=0.570),PFS(P=0.492)or OS(P=0.200)of AMs after GTR,nor could it improve RFS(P=0.727),PFS(P=0.964)or OS(P=0.172)of AMs after STR.Conclusion:Complete resection for AMs is necessary to prolong recurrence-free survival and progression-free survival.However,whether or not PORT is still debatable,because it can not reduce the recurrence rate but increase the risk of death.If there is spontaneous necrosis in the tumor,more attention should be paid to prevent recurrence and death.Part 3 Risk factors of postoperative epilepsy in atypical meningioma patientsObjective:Epilepsy is one of the most common clinical symptoms of meningioma,and the occurrence of postoperative epilepsy is an important indicator of the quality of life after surgery.Nowadays,the factors that affect the occurrence of postoperative epilepsy in benign meningioma patients(BMs)have been studied in depth,but little is known about atypical meningioma.So we aim to study the relationship between preoperative symptoms,laboratory indicators,imaging indicators,surgical condition and postoperative epilepsy in atypical meningioma patients(AMs).Methods:Patients who were diagnosed as atypical meningioma by pathological examination were collected from March 2013 to June 2016 in the neurosurgery department at the Second Affiliated Hospital of Zhejiang University School of Medicine.At the same time,collecting the following data for each patient who met the inclusion criteria:baseline data,image data and follow-up data.Comparing the differences in clinical manifestations,hematology indicators,imaging indicators,surgical condition,etc.between epilepsy group and non-epilepsy group,and some factors that may affect postoperative epilepsy were analysed by univariate analysis and multivariate analysis.Results:A total of 134 AMs were enrolled.Univariate analysis showed that AMs with a history of dizziness and headache had less possibility to occur preoperative epilepsy(P=0.009).AMs with peritumoral edema(P=0.039),larger tumor size(P=0.026),and tumor sites in the frontal lobe(P=0.044)were more prone to occur postoperative epilepsy.Multivariate logistic regression analysis showed that larger tumor size(OR[95%Cl]=1.041[1.004-1.080],P=0.028),and tumor site in the frontal lobe(OR[95%Cl]=0.35[0.12-0.97],P=0.044)were independent risk factors for postoperative epilepsy.Conclusion:The tumor site(frontal lobe)and tumor size are predictive factors for postoperative epilepsy in atypical meningioma patients.Peritumoral edema can also induce postoperative epilepsy,but it is not an independent risk factor. |
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