An Analysis of Prognostic Factors Associated With Recurrence in the Treatment of Atypical Meningiomas

Abstract

Background: There has been increased reporting of atypical meningioma (grade II) since the World Health Organization reclassification in 2000, and the use of postoperative radiation therapy (RT) in the treatment of these tumors is controversial. We evaluated patients treated at our institution to identify patient subgroups with increased risk of recurrence that may benefit from adjuvant RT. Methods and materials: We retrospectively assessed 50 patients treated for World Health Organization grade II meningiomas between March 2000 and February 2013. Sex, race, age of diagnosis, tumor location, performance status, size of tumor, MIB-1 index, resection status, and RT were recorded. Patient follow-up, recurrence, and vital status were measured to assess 3-year overall survival (OS) and recurrence free survival (RFS). Results: The median follow-up was 37 months (range, 1-148). Female sex was associated with decreased RFS compared with male sex (86.1% vs 100%, P Z .047). Subtotal resection demonstrated both inferior RFS (67.5% vs 96.6%, P Z .025) and OS compared with gross total resection (70.0% vs 100%, P < .001). Tumors >4.5 cm had worse RFS than tumors 4.5 cm (85.4% vs 100%, P Z .025). Patient OS was lower in tumors with an MIB-1 index >5% than 5% (89.7% vs 100%, P Z .008). Eastern Cooperative Oncology Group 2-4 negatively impacted OS relative to patients with an Eastern Cooperative Oncology Group 0-1 (66.7% vs 100%, P < .001).Conclusions: Significantly higher rates of recurrence occurred in female sex, subtotal resection, and tumors larger than 4.5 cm. Further studies are needed to confirm these findings and determine whether patients without any of these risk factors can undergo surgical resection without adjuvant radiation therapy.

The tumour volume influence on tumour recurrence and progression-free survival in the case of atypical meningiomas

“…Thus, in cases of meningiomas with tumor volumes ˃ 26.4 cm3, the recurrence rate was higher than in the case of tumors with volumes below this value. This correlation between a larger size of the meningioma and the existence of the risk of tumor recurrence has also been observed by other authors in previous studies (16,17,19).…”

“…Fernandez et al reported that the size of over 4.5 cm of AM is associated with a risk of early recurrence (16). Moreover, Garzon-Muvdi et al also observed in his study that the size of the tumor can be considered an important factor not only for PFS, but also for overall survival.…”

“…Nakasu et al also reported the mean size of 4.4 ± 1.4 cm to influence tumor recurrence compared to non recurrent tumors which had a diameter of 3.5 ± 1.5 cm (25). Moreover, various authors reported that smaller sized AMs can represent a protective factor against tumor recurrence (4,14,16).…”

“…Regarding the multiple prognostic factors of tumor recurrence in case of AMs (8,12,13,27,30,31), some studies have reported that the size and volume of the tumor would also represent a prognostic factor (16,17,22). Thus, some authors have proved that larger size of AMs (for example, over 4.5 cm) are associated with early tumor recurrence (16). Other authors have reached the conclusion that the size of the meningioma is not only a prognostic factor of tumor recurrence, but also of the survival of patients, both in the case of AMs, as well as in the case of anaplastic meningiomas (17).…”

Prognostic Role of Matrix Metalloproteinase Expression in Meningioma: A Cross-Sectional Study.

“…The most signi cant clinical factor is the extent of tumor resection, which is determined by the tumor location, extent of invasion, and skill of the surgeon (5). Fernandez (13) reported that atypical meningioma, female sex, subtotal resection, and tumor size exceeding 4.5 cm were associated with signi cantly higher recurrence rates. Regarding histopathological factors, the most useful predictor for recurrence is the WHO grade.…”