Clinical Features Of Recurrent Meningiomas And Multiple Factors Analysis Of Recurrence Factors

Objective: To study the factors of recurrence of meningiomas and the clinical features of recurrent meningiomas.Methods: The data of 480 patients with meningioma in the Department of Neurosurgery,the First Affiliated Hospital of Dalian Medical University from January 2010 to December 2015 were collected,and 30 patients with recurrent meningiomas were collected.The patients were followed up,the clinical data were not complete and the patients who lost follow up were excluded,and 21 cases of patients with complete recurrent meningioma were selected as the study group.21 patients were randomly selected as the control group from 450 cases of patients with non-recurrent meningioma,and their complete clinical data were obtained.Through single factor analysis between the two groups in age,gender,clinical symptoms,imaging features(shape,position,size)extent of surgical resection,pathological grading,Histological type and Immunohistochemistry(EMA and vimentin,S-100,Ki-67,PR)index difference and the difference significant clinical data and Immunohistochemistry data were logistic regression multivariate analysis.Results:The average age of recurrence group is 62.2 years old,The average age of control group is 57.5 years old.There is no statistical difference in two groups.There is9 men in recurrence group and accounted for 42% of this group,12 women accounted for 58% of this group.There is 6 men in recurrence group and accounted for 29% of this group,15 women accounted for 71% of this group.The proportion of males in recurrence group was higher than that in the control group,but there was no statistical difference between the two groups.The clinical symptoms of recurrence group showed the proportion of epilepsy(29%)was higher than the primary group(14%),but therewas no statistical significance between the two groups.The imaging features in the recurrence group with irregular shape(including lobulated(24%)and mushroom(33%),control group,tumor shape to the main round,two groups with significant differences.Tumor site of recurrence group(convexity 43%,parasagittal by 24%,the base of the skull 19%,9% of tentorium cerebelli,intraventricular 15%)and control group tumor location(convexity 48%,the base of the skull 19%,parasagittal by 14%,tentorium cerebelli 9%,petroclival region 5%,tuberculum sellae 5%)are no statistically difference.The proportion of convex meningioma of recurrence group compared with the control group decreased,the proportion of sagittal sinus meningioma of study group was higher than those in control group.Recurrent tumor group size(< 4 cm(10%),? 4cm(90%))and control group(< 4 cm(86%),? 4 cm(14%)had significant difference.The degree of surgical resection was classified according to Simpson classification criteria,the recurrence group(Grade I 28.5%,II 43%,III 28.5%),the control group(Grade I 81%,II 15%,III 14%),with statistical differences between the two groups.Pathological grading according to the 2007 WHO classification criteria,recurrence group(Grade I 19%,II 57%,III 24%),the primary group(Grade I 81%,II 19%),with statistical differences between the two groups.Histological type,recurrence group(endothelial 14%,mixed type 15%,atypical 62% of malignant and 19%),control group(endothelial type 62%,microcystic 29%,hemangioma type 15%,mixed type 15%,atypical 19%)with statistical differences between the two groups.There were statistically significant differences in PR,Ki-67 and EMA in the immunohistochemical indexes,and there was no statistical difference between vimentin and S-100.Multiple factors analysis: the influence factors of clinical data in the ranking of WHO classification > histology type > tumor size > shape > Simpson Grade,the influence factors of immunohistochemistry index ranking: PR>ki>EMA.Recurrence group was followed up for 19 to 256 months,and the average of followed up time is 120 months,The control group was followed up for 5 to 68 months,an average followed up time is35 months.In the recurrence group,8 people had two recurrence times,2 people had three recurrence times.The average interval between the first operation and the firstrecurrence was 73 months.The average interval between the second operation and the second recurrence was 23 months.The mean interval between the third surgeries and the third recurrence was 9.5 months..There were two patients with recurrent meningioma,their first surgical pathology diagnosis is atypical meningioma,the second surgical pathology diagnosis of malignant meningioma.Conclusions:1.Tumor shape of recurrent meningioma ofen performance as irregular(lobulated,mushroom),tumor size of recurrent meningioma usually performance as much larger,tumor WHO grades performance as much higher,surgical resection with tumor recurrence is closely related,The recurrence rate of Simpson II and III resection was higher than that of grade I.2.In the immunohistochemistry,PR negative suggested that the tumor is easy to recur,Ki-67 > 10% suggested that the tumor is easy to recur,and EMA positive suggested that the tumor is easy to recur.3.Recurrence factors include: Who classification,histological type,tumor size,location,Simpson grade,tumor shape,PR,Ki-67,EMA.