恶性脑膜瘤的临床特征及其复发因素分析

发布时间：2018-03-20 03:35

本文选题：恶性脑膜瘤　切入点：临床特点　出处：《西南医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对比良性脑膜瘤和恶性脑膜瘤的临床特点、影像学情况、手术情况、病理及免疫组化情况,分析恶性脑膜瘤具有的临床特征,明确影响其复发的独立因素。方法:收集于2002年1月~2015年12月在泸州医学院附属医院神经外科就诊、接受开颅手术且术后病理结果证实为恶性脑膜瘤的24例患者的临床资料。并在同期同主刀医师手术患者中随机选择24例资料完整的良性脑膜瘤为对照组。回顾性分析良恶性脑膜瘤患者在临床特点、影像学表现、手术和术后随访情况,并进行统计学分析。通过检测免疫组化标本中Ki67、EMA、Vimentin和CyclinE生物学指标的表达来分析良恶性脑膜瘤在病理学上的差异。结合这些临床特征,对各指标与恶性脑膜瘤术后复发的相关性进行Kaplan-Meier单因素分析,对有意义者再行Cox多因素回归分析,并结合既往文献回顾结果分析判断影响恶性脑膜瘤复发的独立因素。结果:良恶性脑膜瘤在性别、发病年龄、生长部位、肿瘤大小以及临床症状体征等一般临床特点上无明显差异(P0.05);而在死亡率、复发率、CT平扫钙化、增强MRI强化、瘤周水肿以及Ki-67标记指数和手术切除程度上差异明显(P0.05)。恶性脑膜瘤各临床特征与术后复发之间的关系的分析结果:年龄(P=0.009)、瘤周水肿程度(P=0.005)、肿瘤大小(P=0.050)、侵袭性类型(P=0.011)和手术切除程度(P=0.002)具有判断恶性脑膜瘤术后复发的价值。但经多因素回归分析后,剔除侵袭性类型(RR=0.699,95%CI:0.184~2.658,P=0.600)、瘤周水肿程度(RR=2.915,95%CI:0.881~9.648,P=0.080)和肿瘤大小(RR=1.314,95%CI:0.250~6.921,P=0.747),仅有年龄(RR=4.379,95%CI:1.125~17.051,P=0.033)和手术切除程度(RR=3.442,95%CI:1.314~9.016,P=0.012)具有统计学意义。结论:1、目前少有关于恶性脑膜瘤复发和预后的研究且各研究结果间异质性较大。在恶性脑膜瘤临床特征与复发间相关性的生存分析模型中,肿瘤侵袭性类型、瘤周水肿程度和肿瘤大小可能影响患者复发,年龄和手术切除程度是影响恶性脑膜瘤复发的独立因素。2、恶性脑膜瘤具有低发病率、高复发率、高死亡率、磁共振不均匀强化和高度瘤周水肿等临床特点。3、免疫组化Ki-67标记指数对良恶性脑膜瘤具有鉴别诊断价值。4、手术治疗是目前恶性脑膜瘤的首选治疗方式,尽全切肿瘤可控制恶性脑膜瘤复发,改善预后。对所有恶性脑膜瘤患者,尤其是非全切除的恶性脑膜瘤患者行辅助放疗,是必不可少的。
[Abstract]:Objective: to analyze the clinical features of benign meningioma and malignant meningioma by comparing their clinical features, imaging, operation, pathology and immunohistochemistry. Methods: from January 2002 to December 2015, the patients were treated in neurosurgery department, affiliated hospital of Luzhou Medical College. The clinical data of 24 cases of malignant meningioma confirmed by craniotomy and pathologically confirmed. 24 cases of benign meningioma with complete data were randomly selected as control group in the same period. To analyze the clinical features of benign and malignant meningiomas, Imaging findings, surgical and postoperative follow-up, and statistical analysis. The pathological differences of benign and malignant meningiomas were analyzed by detecting the expression of Ki67 EMAVimentin and CyclinE in immunohistochemical specimens. The correlation between the indexes and the recurrence of malignant meningioma after operation was analyzed by Kaplan-Meier univariate analysis, and Cox multivariate regression analysis was performed on the significant patients. The independent factors affecting the recurrence of malignant meningioma were analyzed and judged by reviewing the results of previous literature. Results: benign and malignant meningiomas were located in sex, age of onset and location of growth. There was no significant difference in the size of tumor and clinical symptoms and signs in general clinical features (P 0.05), but in mortality, recurrence rate, CT plain calcification, enhanced MRI enhancement, and no significant difference in general clinical features, such as tumor size, clinical symptoms and signs, etc. There were significant differences in peritumoral edema, Ki-67 labeling index and surgical excision degree. The relationship between the clinical features of malignant meningioma and postoperative recurrence was significant (P 0.05). The results showed that the age of malignant meningioma was 0.009, the degree of peritumoral edema was P0.005, the size of tumor was 0.050%, and the invasive type of malignant meningioma was found. It is valuable to judge the recurrence of malignant meningioma after operation, but after multivariate regression analysis. Excluding the invasive type RRN 0.69995 CI: 0.1844 2.658P0.600, the degree of peritumoral edema is 2.91595CI0.8819.648P0.080) and the size of the tumor RRN1.314995: CI0.2506.921P0.47470.4747, only the age of RRR4.37995CI1.1255.95CI1.12517.051P0.033) and the degree of excision RR3.44295CI1.314149.016P0.012) have statistical significance. Conclusion 1, there are few studies on the recurrence and prognosis of malignant meningioma. In the survival analysis model of the correlation between clinical characteristics and recurrence of malignant meningioma, The invasive type of tumor, the degree of peritumoral edema and the size of tumor may affect the recurrence of patients. Age and surgical resection degree are independent factors affecting the recurrence of malignant meningioma. The malignant meningioma has low incidence, high recurrence rate and high mortality. The clinical features of magnetic resonance inhomogeneous enhancement and high peritumoral edema. The immunohistochemical Ki-67 labeling index is valuable for differential diagnosis of benign and malignant meningiomas. Surgical treatment is the first choice of treatment for malignant meningiomas at present. Total resection of the tumor can control the recurrence of malignant meningioma and improve the prognosis. It is necessary to perform adjuvant radiotherapy for all patients with malignant meningioma, especially those with incomplete resection of malignant meningioma.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.45

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