Progression-Free Survival And Analysis Of The Factors Of Recurrence In Primary Atypical Meningioma

Objective: By analyze the clinical characteristics of patients with primary atypical meningiomas,to investigate the progression-free survival of each index and its correlation with recurrence,to provide guidance for clinical treatment.Methods: 102 primary patients with atypical meningiomas who underwent surgery at The First Affiliated Hospital of Fujian Medical University during January 2009 to December 2017 period were included,The association with postoperative tumor recurrence from index of clinical records was analyzed by log-rank univariate analysis and Cox multivariate factor regression analysis.Result: Among 102 cases of atypical meningiomas,80 cases were totally resected(including Simpson grade I and grade II).The total resection rate was 78.4%.15 patients received radiotherapy after first operation,32 cases relapsed(recurrence rate was 31.4%),the recurrence time was 2-105 months after operation,the mean recurrence time was 31.1 months,and the median recurrence time was 23 months.The mean progression-free survival was 41.2 months and the median progression-free survival was 36.5 months.The progression-free survival rate of 1 year,3 years,5 years and 8years was 91.1%,76.5%,63.2% and 50.7%.Univariate analysis showed that patients with KPS score < 80(P = 0.015),tumor diameter > 5.2cm(P = 0.014),location in moderate / high risk(P = 0.012),bone invasion(P < 0.001),Non-total resection(P =0.001)and Ki 67 ≥ 5%(P = 0.043)were more likely to relapse(P < 0.05).Multivariate analysis showed that the risk factors of tumor recurrence were non-total resection(P =0.002,HR = 4.058),location in moderate / high risk(P = 0.029,HR = 2.717),bone invasion(P = 0.007,HR = 3.439)(P < 0.05).The total resection rates of tumors location in low risk,moderate risk and high risk were 95.2%,72.6% and 33.3%,respectively.The recurrence rate was 100%(10/10)in the bone invasion group,and the progression-free survival was prolonged in the bone invasion group(P=0.004).conclusion:1.The postoperative recurrence of atypical meningioma is independently associated with non-total resection,the tumor location in moderate / high risk means location included parasagittal / falcine and the midline or para-midline area of the skull base,bone invasion.If there are patients with tumor diameter> 5.2 cm,preoperative KPS、score <80 points and Ki67≥5% may affect the risk factors of postoperative recurrence.It is also recommended to follow up closely after surgery.2.Non-total resection is the most important risk factor for tumors to affect tumor recurrence.As far as possible,total resection(Simpson Ⅰ and Ⅱ)can reduce the rate of tumor recurrence and prolong progression-free.For tumors of Non-total resection,radiotherapy is recommended after surgery.3.Total resection when there was bone invasion can prolong progression-free survival.