Surgical Treatment and Predictive Factors for Atypical Meningiomas: A Multicentric Experience.
Adult
Age Factors
Aged
Brain Neoplasms
/ mortality
Female
Follow-Up Studies
Humans
Karnofsky Performance Status
Male
Margins of Excision
Meningioma
/ mortality
Middle Aged
Neoplasm Recurrence, Local
/ epidemiology
Neurosurgical Procedures
/ methods
Postoperative Complications
/ epidemiology
Predictive Value of Tests
Prognosis
Progression-Free Survival
Recurrence
Sex Factors
Treatment Outcome
Atypical meningioma
Grade II meningiomas
Overall survival
Progression-free survival
Tumor recurrence
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
04
03
2020
revised:
27
03
2020
accepted:
29
03
2020
pubmed:
21
4
2020
medline:
21
5
2021
entrez:
21
4
2020
Statut:
ppublish
Résumé
Atypical meningiomas are characterized by a high rate of recurrence and shorter overall survival (OS) compared with grade I meningioma. Predictive parameters for OS and recurrence-free survival (RFS) are controversial. Patient age, sex, preoperative symptoms, tumor localization, size, Simpson grade, postoperative complications, extent of resection, number of mitoses, MIB1 proliferation index, brain invasion, postoperative radiotherapy, and clinical outcome (Karnofsky performance scale [KPS] postoperatively and at long-term follow-up) were evaluated. Data regarding recurrence rate, mortality, OS, and RFS at 1-, 3-, and 5-year follow-up were also collected. Median follow-up was 76 months; all patients had at least 3 years of follow-up. Between 2007 and 2017, 73 patients underwent surgery for atypical meningiomas (World Health Organization grade II) at 2 centers. Preoperative KPS score >80 as well as 1-month, 6-month, and 1-year follow-up KPS scores were related to better OS. Postoperative complications did not modify OS and RFS. Gross total removal (Simpson grade I, II) was achieved in 80.8% of patients. RFS was statistically influenced by extent of resection (P = 0.002). MIB1 proliferation index >8 was a negative predictive factor for recurrence at univariate and multivariate analysis (P = 0.001 and P = 0.021). Radiotherapy was statistically related to a worse outcome. The incidence of recurrence was 38%. RFS was 98.6% at 1-year follow-up, 81.1% at 3 years, and 57.5% at 5 years. All patients were alive at 1-year follow-up. OS was 90.5% at 3-year follow-up and 78.8% at 5-year follow-up. Despite some limitations, our study demonstrates that aggressive surgical treatment achieving a gross total removal is a positive predictive parameter for RFS as well as a good clinical outcome (KPS score >80) and is related to a longer OS.
Sections du résumé
BACKGROUND
Atypical meningiomas are characterized by a high rate of recurrence and shorter overall survival (OS) compared with grade I meningioma. Predictive parameters for OS and recurrence-free survival (RFS) are controversial.
METHODS
Patient age, sex, preoperative symptoms, tumor localization, size, Simpson grade, postoperative complications, extent of resection, number of mitoses, MIB1 proliferation index, brain invasion, postoperative radiotherapy, and clinical outcome (Karnofsky performance scale [KPS] postoperatively and at long-term follow-up) were evaluated. Data regarding recurrence rate, mortality, OS, and RFS at 1-, 3-, and 5-year follow-up were also collected. Median follow-up was 76 months; all patients had at least 3 years of follow-up.
RESULTS
Between 2007 and 2017, 73 patients underwent surgery for atypical meningiomas (World Health Organization grade II) at 2 centers. Preoperative KPS score >80 as well as 1-month, 6-month, and 1-year follow-up KPS scores were related to better OS. Postoperative complications did not modify OS and RFS. Gross total removal (Simpson grade I, II) was achieved in 80.8% of patients. RFS was statistically influenced by extent of resection (P = 0.002). MIB1 proliferation index >8 was a negative predictive factor for recurrence at univariate and multivariate analysis (P = 0.001 and P = 0.021). Radiotherapy was statistically related to a worse outcome. The incidence of recurrence was 38%. RFS was 98.6% at 1-year follow-up, 81.1% at 3 years, and 57.5% at 5 years. All patients were alive at 1-year follow-up. OS was 90.5% at 3-year follow-up and 78.8% at 5-year follow-up.
CONCLUSIONS
Despite some limitations, our study demonstrates that aggressive surgical treatment achieving a gross total removal is a positive predictive parameter for RFS as well as a good clinical outcome (KPS score >80) and is related to a longer OS.
Identifiants
pubmed: 32311549
pii: S1878-8750(20)30672-0
doi: 10.1016/j.wneu.2020.03.201
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1-e8Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.