Prognostic Factors and Outcomes in World Health Organization Grade 1 and Grade 2 Intracranial Meningiomas—5-Year Institutional Experience

Abstract

Meningiomas are the most frequent primary intracranial tumour. While histological grade and grade of excision are established predictors of recurrence, nuances such as the role of radical excision of dural attachment and postoperative radiotherapy in intermediate-risk groups remain unanswered. This report presented data from 451 WHO Grade 1 and 248 WHO Grade 2 intracranial meningiomas operated between 2010 and 2015, analysing their clinical and radiological features and surgical details. Outcomes were assessed among 352 WHO Grade 1 and 208 WHO Grade 2 meningiomas, studying the effect of extent of resection and use of radiotherapy. Kaplan Meier analysis was used to determine differences in survival by extent of resection and use of postoperative radiotherapy in the treatment of WHO Grade 1 and 2 meningiomas. The mean age of the cohort was 46.3 years, with a female predominance. On univariate analysis, gender, WHO grade, and Simpson grade were significant predictors of recurrence. On multivariate analysis, WHO grade and Simpsons grade remained significant predictors of recurrence. Recurrence was significantly associated with poor performance status and mortality. Postoperative radiation significantly improved progression-free survival among Grade 2 meningioma that underwent gross total resection (GTR), but not among WHO Grade 1 and 2 meningioma after subtotal resection (STR). WHO Grade and Simpson grade are independent predictors of recurrence among meningiomas. Irrespective of Grade, gross total resection must be effected when possible, and postoperative radiotherapy may be recommended in Grade 2 meningioma.