Article
Clinical, radiological and histopathological predictors for long-term prognosis after surgery for atypical meningiomas
Klinische, radiologische und histopathologische Prädiktoren für die postoperative Langzeitprognose von atypischen Meningiomen
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Published: | June 26, 2020 |
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Objective: Although considerable rates of recurrence and mortality can be found in atypical meningiomas, reliable predictors for evaluating a long-term prognosis are unclear. On the other hand, determinations of molecular alterations known to correlate with recurrence have not yet been established in routine neuropathological analyses. Therefore, we aimed to determine clinical, radiological and histological risk factors for progression available from routine perioperative data.
Methods: Associations of radiological, clinical and histological variables with recurrence and mortality were retrospectively analyzed by uni- and multivariate analyses.
Results: 138 patients consisting of 64 females and 74 males (46% and 54%, median age 62 years) underwent surgery for intracranial atypical meningioma between 1991 and 2018 were included. Gross total resection (GTR, Simpson grade I+II) could be achieved in 81% of all cases, whereas subtotal resection (STR, Simpson grade ≥III) was achieved in 19%. Within a median follow-up of 62 months, recurrence occurred in 52 (38%) and death in 22 (16%) cases. In patients who did not receive adjuvant irradiation, recurrence rates were higher after STR than after GTR (32% vs 63%, p=.025). In univariate analyses, only intra-tumoral calcifications on preoperative MRI (p=.012) and the presence of brain invasion in the absence of other histological grading criteria (p=.010) were correlated with recurrence. In multivariate analyses, only patient age was positively (HR: 1.03, 95%CI 1.04-1.05; p=.018), and the presence of brain invasion as the only grading criterion (HR: .37, 95%CI .19-.74; p=.005) was negatively associated with progression, while increasing age at the time of surgery (HR: 1.07, 95%CI 1.03-1.12; p=.001) was prognostic for mortality.
Conclusion: Reliable clinical predictors for both progression and mortality in patients with atypical meningiomas are difficult to determine. However, both gross total resection and, after STR, adjuvant irradiation might improve local tumor control rates. PFI was longer in brain-invasive but otherwise histologicalyl benign meningiomas and in tumors displaying calcifications on preoperative MRI.