摘要
目的探讨影响脑膜瘤发生周边骨质侵蚀的相关因素及合并骨质侵蚀患者的预后情况。方法回顾性分析2020年1月至2021年12月福建医科大学附属第一医院神经外科诊治的198例脑膜瘤与周边骨质密切接触患者的临床资料,根据肿瘤侵蚀骨质的程度将患者分为无骨质侵蚀组(149例)和骨质侵蚀组(49例)。比较两组患者的临床一般资料、影像学指标、生化检验指标、病理学指标,将差异有统计学意义的因素纳入多因素logistic回归模型中进一步分析。随访患者术后肿瘤复发情况,应用Kaplan-Meier法计算两组患者术后的无进展生存率,并采用log-rank检验比较两组患者无进展生存率的差异。结果骨质侵蚀组患者的肿瘤最大径和瘤周水肿最大径较无骨质侵蚀组均增大(均P<0.05),骨质侵蚀组患者的血清镁离子浓度较无骨质侵蚀组低(P<0.05),与无骨质侵蚀组比较,骨质侵蚀组的高级别世界卫生组织(WHO)分级占比高(P<0.05),无骨质侵蚀组的神经胶质原纤维酸性蛋白质(GFAP)阳性表达率较骨质侵蚀组高(P<0.05)。多因素logistic回归分析结果显示,血清镁离子浓度升高(OR=0.01,95%CI:0.01~0.95)及肿瘤组织GFAP表达阴性(OR=0.45,95%CI:0.21~0.96)均是脑膜瘤发生骨质侵蚀的独立保护因素(均P<0.05)。术后患者的随访时间为(40.66±6.45)个月(30~53个月)。至末次随访,共6例患者出现肿瘤复发,其中无骨质侵蚀组的复发率为0.7%(1/149),骨质侵蚀组的复发率为10.2%(5/49);198例患者的无进展生存分析显示,骨质侵蚀组的无进展生存率较无骨质侵蚀组高,差异具有统计学意义(P<0.001)。结论血清镁离子浓度升高及肿瘤组织GFAP表达阴性是脑膜瘤发生周边骨质侵蚀的独立保护因素。合并周边骨质侵蚀的脑膜瘤患者复发率高,预后较差。
Objective To explore the factors associated with the peripheral bone erosion in meningiomas and to investigate the relationship between bone erosion and patient prognosis.Methods A retrospective analysis was conducted on the clinical data of 198 patients with meningiomas in close contact with surrounding bone who were diagnosed and treated in the Department of Neurosurgery at the First Affiliated Hospital of Fujian Medical University from January 2020 to December 2021.The patients were divided into two groups based on the degree of tumor invasion into bone:the non-bone erosion group(149 cases)and the bone invasion group(49 cases).The clinical general data,imaging indicators,biochemical examination indicators,and pathological indicators of the two groups of patients were compared,and factors with statistical significance were included in a multivariate logistic model for further analysis.Follow-up of patients′postoperative tumor recurrence was conducted,and the Kaplan-Meier method was used to calculate the progression-free survival rate of patients in both groups.The log-rank test was used to compare the differences in survival rate between the two groups.Results The maximum diameter of the tumor and the diameter of peritumoral edema in the bone erosion group were both larger than those in the non-bone erosion group(both P<0.05),and the serum magnesium concentration in the bone erosion group was lower than that in the non-erosion group(P<0.05).The proportion of high-grade World Health Organization(WHO)classification in the bone erosion group was higher than that in the non-bone erosion group(P<0.05),and the positive expression rate of glial fibrillary acidic protein(GFAP)in the non-bone erosion group was higher than that in the bone erosion group(P<0.05).Multivariate logistic regression analysis showed that increased serum magnesium ion concentration(OR=0.01,95%CI:0.01-0.95)and negative GFAP expression in tumor tissue(OR=0.45,95%CI:0.21-0.96)were independent protective factors for meningioma bone erosion(both P<0.05).The patients were followed up for 40.66±6.45 months(30-53 months).Up to the last follow-up,a total of 6 patients had tumor recurrence,of which the recurrence rate was 0.7%(1/149)in the group without bone erosion and 10.2%(5/49)in the group with bone erosion.Progression-free survival analysis of 198 patients showed that the progression-free survival rate in the bone erosion group was higher than that in the non-bone invasion group,and the difference was statistically significant(P<0.001).Conclusions Increased serum magnesium levels and negative expression of GFAP in tumor tissue are independent protective factors for peripheral bone erosion in meningiomas.Patients with meningiomas with bone erosion have high recurrence rate and poor prognosis.
作者
俞挺
陈人龙
潘吉
梅文忠
林元相
康德智
林清松
吴喜跃
Yu Ting;Chen Renlong;Pan Ji;Mei Wenzhong;Lin Yuanxiang;Kang Dezhi;Lin Qingsong;Wu Xiyue(Department of Neurosurgery,the First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,China)
出处
《中华神经外科杂志》
北大核心
2025年第1期44-50,共7页
Chinese Journal of Neurosurgery
基金
福建省科技创新联合基金(2021Y93070300)。
作者简介
通信作者:吴喜跃,Email:1371860869@qq.com。
