Background: Although its validity has recently been questioned since its introduction, the Simpson grade has remained one of the most relevant factors in estimating the recurrence risk of intracranial meningiomas. This study aims to assess its role in spinal meningiomas through a retrospective analysis of a mono-institutional surgical series and literature meta-analysis. Methods: We conducted a systematic review and meta-analysis of the literature from 1980 to 2023, complemented by a mono-institutional series of 74 patients treated at “Santa Maria delle Grazie” hospital. Demographic, clinical, neuroradiological, pathological, surgical, and outcome data of case series were analyzed. For the meta-analysis, studies were selected based on predefined inclusion criteria, and a fixed-effects model was used to synthesize data due to assumed homogeneity among included studies. Statistical analyses included odds ratios (OR) for recurrence risk and assessment of publication bias using Peter’s test. Results: Mono-institutional sample included 74 patients, most of whom were women (85%) with a median age of 61.9 years. The thoracic spine was the most common tumor location (81%). Recurrences occurred in patients with Simpson grade II and III resections. The meta-analysis involved 2142 patients from 25 studies and revealed a significantly higher recurrence rate for Simpson grades III–V compared to grades I–II (OR 0.10; CI95 0.06–0.16). Additionally, Simpson grade II had a higher recurrence risk than grade I (OR 0.42; CI95 0.20–0.90). Conclusions: The Simpson grading remains a valid predictor of recurrence also for spinal meningiomas. Our findings revealed a significant increase in recurrence rate with higher Simpson grades. These results support the need to strive for Simpson grade I resection when feasible.
背景：尽管自引入以来其有效性近期受到质疑，但Simpson分级仍是评估颅内脑膜瘤复发风险的最相关因素之一。本研究旨在通过单中心手术病例的回顾性分析和文献荟萃分析，评估其在脊髓脑膜瘤中的作用。方法：我们对1980年至2023年的文献进行了系统性回顾与荟萃分析，并补充了在"Santa Maria delle Grazie"医院接受治疗的74例患者的单中心病例数据。分析了病例系列的人口统计学、临床、神经影像学、病理学、手术及预后数据。在荟萃分析中，根据预设纳入标准筛选研究，并基于纳入研究间的同质性假设采用固定效应模型进行数据整合。统计分析包括复发风险的比值比（OR）及使用Peter检验评估发表偏倚。结果：单中心样本包含74例患者，其中女性占大多数（85%），中位年龄61.9岁。胸椎是最常见的肿瘤部位（81%）。复发仅发生在Simpson II级和III级切除的患者中。荟萃分析纳入25项研究的2142例患者，显示Simpson III-V级切除的复发率显著高于I-II级（OR 0.10；95%CI 0.06-0.16）。此外，Simpson II级切除的复发风险高于I级切除（OR 0.42；95%CI 0.20-0.90）。结论：Simpson分级对脊髓脑膜瘤的复发仍具有有效预测价值。我们的研究结果显示，随着Simpson分级升高，复发率显著增加。这些结果支持在可行情况下应努力实现Simpson I级切除。
肿瘤(癌症)患者之家