Clinical features and prognostic factors of WHO II and III adult spinal meningiomas: analysis of 25 cases in a single center

Abstract

Spinal World Health Organization (WHO) II and III meningiomas are relatively rare, and often associated with great clinical aggressiveness and poor overall survival. There are controversies over factors affecting the prognosis of this disease. The aim of this retrospective study was to evaluate factors that may affect the therapeutic outcome and prognosis of adult high-grade spinal meningiomas by reviewing the medical records of 25 patients who were surgically treated in our hospital between 2001 and 2014. Univariate and multivariate analyses were performed to identify prognostic variables relative to patient and tumor characteristics, and treatment modalities. All 25 patients (14 men and 11 women; mean age 46.6 ± 16.1 years) underwent surgical resection. Local recurrence was occurred in 13 (52.0 %) patients, and 10 (40.0 %) patients died during the follow-up periods. The 5-year recurrence rate was 60.0 % and the 5-year survival rate was 68.0 %. The results of statistical analysis suggested that Simpson resection grade and the number of involved segments were prognostic factors related to progression-free survival and that sex, age, preoperative Frankel score, the number of involved segments and WHO grade were closely correlated with survival. Furthermore, we confirmed that the number of involved segments was the major independent factor affecting recurrence of patients with adult spinal high-grade meningiomas, and that sex, age and WHO grade were prognostic factors affecting survival but not recurrence.

Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1)

“…Similarly, most studies on WHO grade 2 and 3 tumors reported an average patient age significantly lower than that of the general meningioma population. For example, a study of 12 patients with WHO grade 2 Clear cell spinal meningiomas reported an average age of 28.8 years [ 35 ], and two other studies with mixed higher grades (WHO grades 2 and 3) in 16 and 25 patients reported a mean age of 52.8 [ 36 ] and 46.6 years [ 37 ], respectively. In one study, reporting on 13 patients with WHO grade 2 atypical meningiomas, a mean age of 65.7 years was reported [ 38 ].…”

“…Contradictory outcomes were also reported in studies offering adjuvant therapy. While some reported no complications or recurrence of tumors [ 36 , 62 , 88 ], others encountered major adverse events and did not benefit from the treatment [ 37 , 53 , 59 , 89 , 90 ]. Hence, no clear conclusions can be drawn regarding the use of adjuvant radiation for the targeted patient groups.…”

Current Knowledge on Spinal Meningiomas—Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2)

“…The potential effect of WHO grade on the complication rate was rarely mentioned. In the five studies on spinal meningiomas with higher WHO grades [ 51 , 52 , 53 , 54 , 55 ], ten complications were detected in the 94 patients included, amounting to a complication rate of 10.6%. Less invasive procedures may be associated with lower complication rates.…”

Unsuccessful external validation of the MAC-score for predicting increased MIB-1 index in patients with spinal meningiomas

“…(28)(29)(30)(31) Notably, several studies have also failed to find any significant correlation between age and tumor recurrence. (5,7,21,32) Previous studies also indicate that elderly patients benefit from surgery for spinal meningiomas and there are no significant differences regarding extent of surgery, complications, or recurrence. (4,5,7,33,34) Studies on the correlation between age and MIB-1-index in cranial meningiomas have failed to show significant results.…”