Meningioma classification and treatment have evolved over the past eight decades. Since Bailey, Cushing, and Eisenhart’s description of meningiomas in the 1920s and 1930s, there have been continual advances in clinical stratification by histopathology, radiography and, most recently, molecular profiling, to improve prognostication and predict response to therapy. Precise and accurate classification is essential to optimizing management for patients with meningioma, which involves surveillance imaging, surgery, primary or adjuvant radiotherapy, and consideration for clinical trials. Currently, the World Health Organization (WHO) grade, extent of resection (EOR), and patient characteristics are used to guide management. While these have demonstrated reliability, a substantial number of seemingly benign lesions recur, suggesting opportunities for improvement of risk stratification. Furthermore, the role of adjuvant radiotherapy for grade 1 and 2 meningioma remains controversial. Over the last decade, numerous studies investigating the molecular drivers of clinical aggressiveness have been reported, with the identification of molecular markers that carry clinical implications as well as biomarkers of radiotherapy response. Here, we review the historical context of current practices, highlight recent molecular discoveries, and discuss the challenges of translating these findings into clinical practice.
脑膜瘤的分类与治疗在过去八十年间持续演进。自20世纪20至30年代Bailey、Cushing和Eisenhart首次系统描述脑膜瘤以来，临床分层体系通过组织病理学、影像学及近年兴起的分子谱分析不断精进，以优化预后评估和治疗反应预测。精准可靠的分类对脑膜瘤患者个体化治疗至关重要，其管理策略涵盖影像学监测、手术切除、原发性或辅助性放射治疗以及临床试验评估。当前临床实践主要依据世界卫生组织（WHO）分级、切除范围（EOR）及患者特征制定治疗方案。尽管现有体系已展现可靠性，仍有大量看似良性的病变出现复发，提示风险分层体系存在优化空间。此外，针对1级和2级脑膜瘤的辅助放疗作用仍存争议。近十年来，多项研究揭示了临床侵袭性的分子驱动机制，不仅识别出具有临床指导价值的分子标志物，还发现了放疗反应相关的生物标志物。本文系统回顾现有诊疗规范的历史沿革，重点阐述近期分子生物学研究进展，并探讨将这些发现转化为临床实践所面临的挑战。
肿瘤(癌症)患者之家