Abstract
ObjectiveAdjuvant radiotherapy is the main treatment modality for high grade meningioma after surgical resection; however, recurrence and survival outcomes vary. The aim of this study was to create a new “prognostic score” that allows personalized recommendations for post-operative adjuvant radiotherapy in patients with high grade meningioma.MethodsClinical data were collected from 115 patients with high grade meningioma treated with surgical resection and adjuvant radiotherapy. A prognostic model was built based on the hazards ratios of independent prognostic factors yielded by multivariate cox proportional analysis. Calibration and discrimination of the prognostic score was evaluated using good of fit test and Harrel’s C index, respectively.ResultsA total of 115 high grade meningioma patients (72 atypical and 43 anaplastic meningiomas) were enrolled. Three factors were independently associated with progression-free survival (PFS): extent of resection (GTR vs. STR), recurrent status (de novo vs. recurrent), and Ki-67 labeling index (<5% vs. ≥ 5%). The respective β-coefficients were used to generate the “prognostic score”. The cohort was divided into low-risk and high-risk groups based on the median prognostic score. Good of fit test showed strong calibration (P = 0.7133) and Harrel’s C index 0.766 indicated a strong discrimination capability of the prognostic score. The Harrel’s C index for OS was 0.60.ConclusionsOur prognostic model using three basic clinical parameters robustly separated high grade meningioma patients who benefit vs. do not benefit from adjuvant radiotherapy. External validation of our model is warranted to help improve patient selection suitable for adjuvant radiotherapy.
Highlights
Meningioma is one of the most common primary neoplasms arising in the central nervous system (CNS), accounting for about 36.4% of all CNS tumors [1]
A total of 115 patients with high grade meningioma treated with surgical resection followed by adjuvant radiotherapy at the Neurosurgical center of Huashan Hospital, Fudan University met the inclusion criterion
The 5-year recurrence free survival rate after adjuvant radiotherapy for grade II meningioma ranges from 48% to 68%, while in grade III meningioma, it drops to 8%–61%, which is quite consistent with our results [16, 17, 20, 25,26,27,28]
Summary
Meningioma is one of the most common primary neoplasms arising in the central nervous system (CNS), accounting for about 36.4% of all CNS tumors [1]. It has been classified into three grades and fifteen histological subtypes according to the World Health Organization (WHO) 2016 meningioma grading criterion [2]. WHO Grade II meningioma was defined by 4–19 mitoses per 10 hpf, brain invasion or presence of the histological features associated with atypia. WHO Grade III meningiomas have a mitotic index higher than 20 per 10 hpf [2]. Atypical (grade II) and anaplastic meningioma (grade III) represent the most common two subtypes. Studies report 5-year survival rates ranging from 78% to 91% and 35% to 79% for atypical and anaplastic meningioma, respectively [3,4,5,6,7,8,9,10,11,12,13]
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