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The Simpson grading: defining the optimal threshold for gross total resection in meningioma surgery.
Neurosurgical Review ( IF 2.5 ) Pub Date : 2020-08-18 , DOI: 10.1007/s10143-020-01369-1
Benjamin Brokinkel 1 , Dorothee Cäcilia Spille 1 , Caroline Brokinkel 2 , Katharina Hess 3 , Werner Paulus 3 , Eike Bormann 4 , Walter Stummer 1
Affiliation  

Classification of the extent of resection into gross and subtotal resection (GTR and STR) after meningioma surgery is derived from the Simpson grading. Although utilized to indicate adjuvant treatment or study inclusion, conflicting definitions of STR in terms of designation of Simpson grade III resections exist. Correlations of Simpson grading and dichotomized scales (Simpson grades I–II vs ≥ III and grade I–III vs ≥ IV) with postoperative recurrence/progression were compared using Cox regression models. Predictive values were further compared by time-dependent receiver operating curve (tdROC) analyses. In 939 patients (28% males, 72% females) harboring WHO grade I (88%) and II/III (12%) meningiomas, Simpson grade I, II, III, IV, and V resections were achieved in 29%, 48%, 11%, 11%, and < .5%, respectively. Recurrence/progression was observed in 112 individuals (12%) and correlated with Simpson grading (p = .003). The risk of recurrence/progression was increased after STR in both dichotomized scales but higher when subsuming Simpson grade ≥ IV than grade ≥ III resections (HR: 2.49, 95%CI 1.50–4.12; p < .001 vs HR: 1.67, 95%CI 1.12–2.50; p = .012). tdROC analyses showed moderate predictive values for the Simpson grading and significantly (p < .05) lower values for both dichotomized scales. AUC values differed less between the Simpson grading and the dichotomization into grade I–III vs ≥ IV than grade I–II vs ≥ III resections. Dichotomization of the extent of resection is associated with a loss of the prognostic value. The value for the prediction of progression/recurrence is higher when dichotomizing into Simpson grade I–III vs ≥ IV than into grade I–II vs ≥ III resections.



中文翻译:

Simpson 分级:确定脑膜瘤手术中全切除的最佳阈值。

脑膜瘤手术后切除范围分为大体切除和次全切除(GTR 和 STR)的分类来自 Simpson 分级。尽管用于指示辅助治疗或研究纳入,但在 Simpson III 级切除的指定方面,STR 的定义存在冲突。使用 Cox 回归模型比较了 Simpson 分级和二分量表(Simpson 等级 I-II vs ≥ III 和等级 I-III vs ≥ IV)与术后复发/进展的相关性。预测值通过时间依赖性接收器操作曲线 (tdROC) 分析进行了进一步比较。在 939 名患有 WHO I 级(88%)和 II/III 级(12%)脑膜瘤的患者(28% 男性,72% 女性)中,Simpson 的 I、II、III、IV 和 V 级脑膜瘤切除率为 29%,48分别为 %、11%、11% 和 < .5%。p  = .003)。STR 后复发/进展的风险在两个二分量表中都增加了,但当包含 Simpson ≥ IV 级时比 ≥ III 级切除时更高(HR:2.49,95%CI 1.50-4.12;p  < .001 vs HR:1.67,95% CI 1.12–2.50;p  = .012)。tdROC 分析显示 Simpson 分级的预测值适中,且显着 ( p < .05) 两个二分法的较低值。Simpson 分级和 I-III 级与 ≥ IV 级切除术之间的 AUC 值差异小于 I-II 级与 ≥ III 级切除术。切除范围的二分法与预后价值的丧失有关。将 Simpson I-III 级 vs ≥ IV 分为 I-II 级 vs ≥ III 切除时,进展/复发的预测值更高。

更新日期:2020-08-18
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