Abstract
Objective: In this study, we identify clinical, radiographic, and histopathologic prognosticators of overall, early, and post-median recurrence in World Health Organization (WHO) grade I meningiomas. We also determine a clinically relevant cutoff for MIB-1 to identify patients at high risk for recurrence.Method: A retrospective review of WHO grade I meningioma patients with available MIB-1 index data who underwent treatment at our institution from 2007 to 2017 was performed. Univariate and multivariate analyses, and recursive partitioning analysis (RPA), were used to identify risk factors for overall, early (within 24 months), and post-median (>24 months post-treatment) recurrence.Result: A total of 239 patients were included. The mean age was 60.0 years, and 69.5% of patients were female. The average follow-up was 41.1 months. All patients received surgery and 2 patients each received either adjuvant radiotherapy (2/239) or gamma knife treatment (2/239). The incidence of recurrence was 10.9% (26/239 patients), with an average time to recurrence of 33.2 months (6–105 months). Posterior fossa tumor location (p = 0.004), MIB-1 staining (p = 0.008), nuclear atypia (p = 0.003), and STR (p < 0.001) were independently associated with an increased risk of recurrence on cox-regression analysis. RPA for overall recurrence highlighted extent of resection, and after gross total resection (GTR), a MIB-1 index cutoff of 4.5% as key prognostic factors for recurrence. Patients with a GTR and MIB-1 >4.5% had a similar incidence of recurrence as those with STR (18.8 vs. 18.6%). Variables independently associated with early recurrence on binary logistic regression modeling included STR (p = 0.002) and nuclear atypia (p = 0.019). RPA confirmed STR as associated with early recurrence.Conclusion: STR, posterior fossa location, nuclear atypia, and elevated MIB-1 index are prognostic factors for WHO grade I meningioma recurrence. Moreover, MIB-1 index >4.5% is prognostic for recurrence in patients with GTR. Verification of our findings in larger, multi-institutional studies could enable risk stratification and recommendations for adjuvant radiotherapy following resection of WHO grade I meningiomas.
Highlights
Meningiomas are the most common primary central nervous system (CNS) neoplasm and account for over 37% of all primary brain tumors [1]
Our results suggest that patients with an elevated MIB-1 index and nuclear atypia on pathologic analysis, posterior fossa location of their tumor, and Subtotal resection (STR) are at higher risk for recurrence and should be considered for closer follow-up or even adjuvant radiotherapy
There remains a paucity of literature on specific predictors of recurrence in World Health Organization (WHO) grade I meningiomas
Summary
Meningiomas are the most common primary central nervous system (CNS) neoplasm and account for over 37% of all primary brain tumors [1]. Management options for meningiomas include observation, surgery, and radiotherapy [2, 3]. While a minority of meningiomas are aggressive, including World Health Organization (WHO) grades II and III, over 80% are WHO grade I, and often called “benign” [4]. Even WHO grade I meningiomas can recur, with previous studies highlighting a recurrence rate of up to 47% with long-term follow-up [4, 5]. Meningioma recurrence frequently necessitates treatment with additional surgery or salvage radiotherapy, leading to potential morbidity [6, 7]. The ability to predict recurrence is a crucial component of WHO grade I meningioma management to make recommendations regarding the frequency of surveillance imaging, or the use of adjuvant radiotherapy
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