蝶骨嵴脑膜瘤中Survivin表达的意义及其显微手术治疗与影响术后复发的相关因素分析

发布时间：2018-05-01 21:08

本文选题：蝶骨嵴脑膜瘤 + 凋亡抑制蛋白Survivin　；参考：《华中科技大学》2015年博士论文

【摘要】：目的：探讨凋亡抑制蛋白Survivin (LAPS)在蝶骨嵴脑膜瘤(SWMs)中表达的意义并分析IAPS表达与SWMs临床预后的关系,为评估SWMs的发展状态和预测临床预后提供新的参考依据。方法：1.总结2000年1月至2014年10月期间华中科技大学附属同济医院神经外科收治的84例SWMs患者的临床资料及术后随访资料,按照肿瘤不同的特征对样本进行分层,并对随访期间复发及死亡的相关资料进行汇总分析。2.采用SP免疫组织化学方法,检测不同特征SWMs病理标本组织切片中IAPS的表达情况,统计IAPS阳性表达率及表达强度的差异,分析IAPS表达与SWMs临床预后的关系。结果：1.本组84例样本中IAPS的阳性表达率为53.6%,其阳性表达率及表达强度在不同病理级别、侵犯颅骨骨质与否、死亡与否、原发首次手术与复发再次手术、复发与未复发样本之间存在明显差异。2.高IAPS表达强度(Intensity Distribution Score,IDS6-12)患者死亡和复发风险明显高于低IAPS表达强度(IDS0-4)患者。结论：1.IAPS在SWMs中存在高表达,并和脑膜瘤的病理组织学分级密切相关,其阳性表达率及表达强度随肿瘤的病理级别增高而增高。2.伴颅骨骨质侵袭、复发及死亡样本的IAPS阳性表达率及表达强度均高于不伴颅骨骨质侵袭、未复发及存活的样本。3.IAPS在SWMs的发生、发展及演变中扮演了重要的角色,其高表达状态可做为评估患者术后复发或死亡风险性的参考指标。目的：探讨蝶骨嵴脑膜瘤(SWMs)的显微外科手术策略并分析影响其术后复发的相关因素,为提高SWMs的手术全切除率及降低术后复发率提供新的思路和方法。方法：回顾性分析2004年1月至2014年10月期间,华中科技大学附属同济医院神经外科显微外科手术切除的121例SWMs患者的临床资料和术后随访资料。对不同临床特征SWMs的手术策略进行分类总结,并将可能影响其术后复发的因素如：性别、年龄、肿瘤的形态、生物学行为特征、手术切除程度和病理级别等资料进行分类统计学分析。应用Kaplan-Meier法、log-rank检验及Cox比例风险回归模型分析影响SWMs术后复发的相关危险因素。结果：1.本组121例病例总体全切除率(Simpson Ⅰ级和Ⅱ级)为61.2%。术后死亡2例,109例患者获严密随访,肿瘤复发28例,复发率25.7%,‘复发时间为8月-74月不等,平均39.1个月。2.统计分析显示：性别、年龄、肿瘤大小及位置与SWMs术后复发无明显相关性；肿瘤的不同生物学行为特征、手术切除程度和病理分型与SWMs术后复发存在一定的相关性。结论：1.术中遵循严格蛛网膜层面操作、对肿瘤实施去血管化、尽可能施行原位切除等显微手术策略,可以大大提高手术的安全性并获得满意的手术效果。2.针对不同生物学行为特征的SWMs,采用不同的显微手术技巧,可以在最大程度减少周围脑组织损伤的基础上,实现最大范围的肿瘤切除,提高肿瘤的全切除率是降低术后复发率的重要手段。3.肿瘤侵犯海绵窦或颅骨骨质、包绕颈内动脉及其分支、恶性病理学特征及未能实现全切除是影响SWMs术后复发的独立危险因素,可做为预测SWMs术后复发危险性的参考因素。
[Abstract]:Objective: To investigate the significance of the expression of apoptosis inhibitory protein Survivin (LAPS) in sphenoid ridge meningioma (SWMs) and to analyze the relationship between IAPS expression and the clinical prognosis of SWMs, so as to provide a new reference for evaluating the development of SWMs and predicting the prognosis of the clinical prognosis.
Methods: 1. to sum up the clinical data and follow-up data of 84 SWMs patients admitted to Department of Neurosurgery of Tongji Hospital Affiliated to Huazhong University of Science and Technology from January 2000 to October 2014. According to the different characteristics of the tumor, the samples were stratified, and the related data of recurrence and death during the follow-up period were summarized and analyzed by.2. immunohistochemistry. To study the expression of IAPS in the tissue sections of SWMs pathological specimens of different characteristics, the difference of IAPS positive expression rate and expression intensity were statistically analyzed, and the relationship between the expression of IAPS and the clinical prognosis of SWMs was analyzed.
Results: 1. the positive expression rate of IAPS in 84 samples of the group was 53.6%, the positive expression rate and expression intensity were at different pathological grades, the invasion of skull bone or not, the death or not, the original first operation and recurrence, and the significant difference of.2. high IAPS expression between the relapse and the non recurrent samples (Intensity Distribution Score, IDS6 -12) the risk of death and recurrence was significantly higher than that of patients with low IAPS expression (IDS0-4).
Conclusion: 1.IAPS is highly expressed in SWMs and is closely related to the histopathological classification of meningiomas. The positive expression rate and expression intensity of the tumor increase with the histopathological grade of the tumor, which increases.2. with the invasion of the skull bone. The positive expression rate and expression intensity of the IAPS in the recurrent and dead samples are higher than that without the invasion of the skull bone, no recurrence and survival. The living sample.3.IAPS plays an important role in the occurrence, development and evolution of SWMs, and its high expression can be used as a reference for assessing the risk of postoperative recurrence or death of patients.
Objective: To explore the microsurgical strategy of sphenoid ridge meningioma (SWMs) and to analyze the related factors that affect the recurrence of the postoperatively, so as to provide new ideas and methods for improving the total resection rate of SWMs and reducing the recurrence rate after operation.
Methods: the clinical data and follow-up data of 121 SWMs patients who were removed from the Department of Neurosurgery of Tongji Hospital, Huazhong University of Science and Technology from January 2004 to October 2014 were analyzed retrospectively. The surgical strategies of different clinical features of SWMs were classified and the factors that might affect the recurrence of the patients, such as sex, were analyzed. Age, tumor morphology, biological behavior characteristics, surgical excision degree and pathological grade were classified and analyzed. Kaplan-Meier, log-rank test and Cox proportional risk regression model were used to analyze the related risk factors of recurrence after SWMs.
Results: 1. the total total resection rate of 121 cases (grade Simpson I and II) was 2 cases of death after 61.2%. and 109 patients were followed up closely. The recurrence rate was 25.7%. The recurrence time was -74 months in August. The average.2. statistical analysis of 39.1 months showed that sex, age, tumor size and location were not obvious after SWMs. Correlation, the different biological behavior characteristics of tumor, surgical resection degree and pathological type were correlated with recurrence after SWMs.
Conclusion: in the 1. operation, the operation of the arachnoid layer is strictly followed, the tumor is removed from the tumor, and the microsurgical strategy can be performed as far as possible. It can greatly improve the safety of the operation and obtain the satisfactory results of the operation.2. for different biological behavior characteristics of SWMs. On the basis of the injury of the surrounding brain tissue, the maximum resection of the tumor and the improvement of total resection rate of the tumor are the important means to reduce the recurrence rate after the operation:.3. tumor invasion of the cavernous sinus or the skull bone, the internal carotid artery and its branches, the malignant pathological characteristics and the failure to realize total resection is an independent risk factor for the recurrence of SWMs after the operation. It can be used as a reference factor to predict the risk of recurrence after SWMs.

【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R739.45

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