Abstract
PurposeWe aim to investigate the impacts of extent of resection and adjuvant radiotherapy on survival of high-grade meningiomas (WHO grade II–III) according to modern diagnosis and management.MethodsPatients with high-grade meningiomas were identified in the Surveillance Epidemiology and End Results (SEER) database between 2000 and 2015 and used for survival analysis. Propensity score matching (PSM) was conducted to reduce selection bias. Another 92 patients from Sun Yat-sen University Cancer Center (SYSUCC) were used for validation.Results530 patients were enrolled from SEER. Patients with gross total resection (GTR) had no significantly different overall survival (OS) compared with those with subtotal resection (STR), even after performing PSM between these two groups. Multivariable analysis found that age ≥ 65 years (HR 2.22, P < 0.001), tumor diameter > 6 cm (HR 1.59, P = 0.004) and grade III tumor (HR 4.31, P < 0.001) were associated with worse OS. Stratification analysis showed that adjuvant radiotherapy conferred significantly improved OS for grade III meningiomas, but not for grade II meningiomas, regardless of resection extent. In SYSUCC cohort, resection extent was also not significantly associated with OS. However, patients with GTR (Simpson grade I–III) had distinctly increased progression-free survival (PFS) than those with STR (P < 0.001). Additionally, for grade II meningiomas after GTR, radiotherapy was unable to improve OS and PFS.ConclusionOn modern management of high-grade meningiomas, GTR does not improve OS, but seems to be associated with increased PFS. Radiotherapy is reasonable as a supplement for treating grade III meningiomas, whereas its effect for grade II meningiomas remains uncertain and needs further validation by prospective study.
Highlights
Meningiomas are the most common primary intracranial tumors in adults, accounting for over 35% of all primary central nervous system (CNS) tumors [1]
Meningiomas identified in Surveillance Epidemiology and End Results (SEER) database with a behavior code of benign were excluded and the remain patients with malignant or borderline behavior were recognized as high-grade meningiomas for analysis
SEER database has been used for reporting the role of extent of resection and radiotherapy for Meningiomas are typically diagnosed by magnetic resonance imaging (MRI) and CT imaging
Summary
Meningiomas are the most common primary intracranial tumors in adults, accounting for over 35% of all primary central nervous system (CNS) tumors [1]. Before 2000, diagnosis and classification of meningiomas as grade II or grade III were highly subjective, but these have been gradually improved by using more detailed standardizations including establish of cutoff values of mitotic counts (WHO 2000 criteria) and introduction of brain invasion (WHO 2007 criteria) for grading assessment [2, 4]. This modification caused increase of the incidence of high-grade meningiomas and showed more power to predict clinical outcomes [5, 6]
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