| Background and objectiveIn 2016,WHO classification standard updated the pathological diagnosis standard of atypical(WHO grade II)meningioma,which made the diagnosis proportion of atypical meningioma increase significantly.Follow with the increasement,the heterogeneity of patients,different clinicians’ choices of surgery,and whether to give postoperative adjuvant radiotherapy all made the prognosis gap of atypical meningioma patients larger.In this retrospective study,the recurrence free survival time,progression free survival time and overall survival time were obtained through follow-up data,and the factors that may affect these prognostic indicators were explored,especially the significance of tumor location,the extent of resection and postoperative radiotherapy on the long-term prognosis of patients with atypical meningioma,and also explored how the long-term prognosis of patients with atypical meningioma affected by preoperative peripheral blood inflammatory indicators.MethodsCollect patients from January 2013 to September 2020,who received surgical resection in department of neurosurgery of the Second Affiliated Hospital of Zhejiang University School of Medicine and pathologically diagnosed as atypical meningioma(WHO grade II).Through the standard about how to include in and out,collect the patient’s information,including demographic information,basic diseases,peripheral inflammation index,imaging data,operation information,neuropathology,postoperative adjuvant therapy and follow-up data.The above data were preliminarily analyzed using univariate Cox survival regression analysis and Kaplan-Meier survival curve comparison.According to the results above,factors that may influence the prognosis of patients with atypical meningioma and factors of clinical concern were then included in the multivariate Cox survival regression analysis to explore factors that may independently influence the prognosis of patients.ResultsA total of 310 patients were included in this retrospective study,including 123 males and 187 females.The median age of patients was 62(54-68)years and the median follow-up time was 53(30-69)months.Female(P=0.038),convex meningioma(P=0.078)and gross total resection(P=0.001)were independent protective factors for postoperative recurrence of atypical meningioma patients.Young age(P=0.001),low grade of activities of daily living(P=0.094)and no peritumor severe edema(P=0.033)were independent protective factors for postoperative all-cause mortality in patients with atypical meningioma.Female(P=0.030),younger age(P=0.041),convex meningioma(P=0.058)and total resection(P=0.002)were independent protective factors for postoperative progression in patients with atypical meningioma.The effect of these factors was confirmed in the gross total resection subgroup,the 5-year recurrence free survival rate,overall survival rate and progression free survival rate were all 100%.However,postoperative adjuvant radiotherapy had no significant effect on the prognosis of all patients with atypical meningioma or patients subgroup undergoing gross total resection.In studies on peripheral blood inflammatory indicators,high lymphocyte count(P=0.058)was an independent risk factor for postoperative recurrence in patients with atypical meningioma.Other results,including the effect of high C-reactive protein on postoperative recurrence,the effect of high neutrophil-lymphocyte ratio and high C-reactive protein on postoperative all-cause mortality,and the effect of high C-reactive protein on postoperative progression,which was shown to be a risk factor for prognosis in patients with atypical meningioma only in univariate Cox survival regression analysis,but did not show significant differences in multivariate Cox survival regression analysis.ConclusionYoung age,female,low grade of activities of daily living,no peritumor severe edema,convex tumor,and total resection tumor are the predictors of good postoperative prognosis in patients with atypical meningioma.These results were further confirmed in the subgroup of patients with atypical meningioma who underwent gross total resection,in which patients with convex meningioma had the best prognosis.However,postoperative adjuvant radiotherapy had no significant effect on the prognosis of all patients with atypical meningiomas or the subgroup undergoing gross total resection.In the study of peripheral blood inflammatory indicators,we found that high peripheral blood inflammatory indicators indicated poor prognosis of patients with atypical meningioma,but most of them lacked significant differences. |
