Long Term Surgical Outcome and Prognostic Factors of Atypical and Malignant Meningiomas.

Yu-Chi Wang,Chieh-Tsai Wu,Yao-Liang Chen,Peng-Wei Hsu,Yung-Hsin Hsu,Tzu-Kan Lin,Shih-Tseng Lee,Yin-Cheng Huang,Cheng-Nen Chang,Chun-Chieh Wang,Chen-Kan Tseng,Pin-Yuan Chen,Kuo-Chen Wei,Chi-Cheng Chuang

doi:10.1038/srep35743

Yu-Chi Wang, Chieh-Tsai Wu + Show 12 more

Open Access

https://doi.org/10.1038/srep35743

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Abstract

Atypical and malignant meningiomas are rare. Our aim was to examine the treatment outcomes following surgical resection, and analyze associations between clinical characteristics and overall survival (OS) or relapse free survival (RFS). 102 patients with atypical or malignant meningiomas underwent microsurgical resection between June 2001 and November 2009 were analyzed retrospectively. We compared demographics, clinical characteristics, treatment, and complications. The five-year and ten-year overall survival rates were 93.5% and 83.4%, respectively. Three factors significantly reduced OS: Malignant meningiomas (p < 0.001), which also decreased RFS (p < 0.001); female patients (p = 0.049), and patients with Karnofsky Performance Status (KPS) < 70 at diagnosis (p = 0.009). Fifty two patients (51%) experienced tumor relapse. Total resection of tumors significantly impacted RFS (p = 0.013). Tumors located at parasagittal and posterior fossa area lead to higher relapse rate (p = 0.004). Subtotal resection without adjuvant radiotherapy lead to the worst local control of tumor (p = 0.030). An MIB-1 index <8% improved OS and RFS (p = 0.003). Total resection of atypical and malignant meningiomas provided better outcome and local control. Adjuvant radiation therapy is indicated for patients with malignant meningiomas, with incompletely excised tumors; or with tumors in the parasagittal or posterior fossa area. The MIB-1 index of the tumor is an independent prognostic factor of clinical outcome.

Highlights

Meningiomas, one of the most common intracranial tumors, accounts for 13% to 26% of brain tumors and have an annual incidence of 6 per 100,000 people[1]
Perr et al reported that the median survival time for patients with grade II lesions ranged from 10 to 14 years and they showed 75% 5-year overall survival rate
We previously showed that Gross total resection (GTR) increases progression free survival in patients with skull base atypical meningiomas[31], consistent with previous findings by Yang et al.[32], Goyal et al.[7], and Zaher et al.[33]

Summary

Introduction

Meningiomas, one of the most common intracranial tumors, accounts for 13% to 26% of brain tumors and have an annual incidence of 6 per 100,000 people[1]. The standards are based on both of subjective and objective (mitotic index) criteria[2]: around 90% are benign (WHO grade I), 5–7% are atypical (WHO grade II), and only 1–3% are considered anaplastic or malignant (WHO grade III)[3] This recent adoption of modern grading criteria and the rarity of the malignant subtype have limited the amount of available data on the clinical behavior, outcomes, and optimal treatment of meningiomas[4]. Previous literature shows that age less than 40 years, cranial base meningiomas, and male sex are associated with recurrence in benign meningiomas that have been subtotally excised, but such data are not available for atypical and anaplastic meningiomas[1,10] Both benign and malignant meningiomas have an equal propensity to bleed, whereas malignant tumors are not necessarily more vascular than benign tumors[1]. There is evidence supporting early addition of adjuvant radiotherapy after GTR to achieve better local tumor control[15,20], but this is not universally recommended[21,22]

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