Clinical, radiological, and histopathological predictors for long-term prognosis after surgery for atypical meningiomas

Streckert, Eileen Maria Susanne; Heß, Katharina; Sporns, Peter; Adeli, Alborz; Brokinkel, Caroline; Kříž, Jan; Holling, Markus; Eich, Hans Theodor; Paulus, Werner; Spille, Dorothee Cäcilia; Eck, Albertus T C J van; Raleigh, David R.; McDermott, Michael W.; Stummer, Walter; Brokinkel, Benjamin

doi:10.1007/s00701-019-03956-8

Cited by 26 publications

(21 citation statements)

References 40 publications

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“…But the potential relation between sex and survival in atypical meningioma need to be further explored. Older patients more than 67.5 years had an increased risk of mortality, in our study, compared with those who were under 67.5 years, which was consistent with previous studies ( 13 – 15 ).…”

Section: Discussionsupporting

confidence: 93%

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Clinical Factors and Outcomes of Atypical Meningioma: A Population-Based Study

2021

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ObjectiveAtypical meningioma is a non-benign tumor, and its prognostic factors and treatment strategies are unclear.MethodsPatients with atypical meningioma, between 2004 and 2016, were collected from the Surveillance, Epidemiology, and End Results database. Then, we randomly divided patients into a training set and a validation set at a ratio of 8:2. The nomogram was constructed based on the multivariate Cox regression analyses. And the concordance index, calibration curves, and receiver operating character were used to assess the predictive ability of the nomogram. We divided the patient scores into three groups and constructed a survival curve using Kaplan–Meier analysis.ResultsAfter our inclusion and exclusion criteria, 2358 patients were histologically diagnosed of atypical meningioma. The prognostic nomogram comprised factors of overall survival, including age, tumor size and surgery. The concordance index was 0.715 (95%CI=0.688-0.742) for overall survival in the training set and 0.688 (95%CI=0.629-0.747) for overall survival in the validation set. The calibration curves and receiver operating character also indicated the good predictability of the nomogram. Risk stratification revealed a statistically significant difference among the three groups of patients according to quartiles of risk score.ConclusionGross total resection is an independent factor for survival, and radiation after non-gross total resection potentially confers a survival advantage for patients with atypical meningioma.

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Section: Discussionsupporting

confidence: 93%

“…Univariate analysis was performed first and variables were inclusion for multivariate analysis if the univariate p value<0. 15.…”

Section: Construction and Validation Of The Nomogrammentioning

confidence: 99%

Clinical Factors and Outcomes of Atypical Meningioma: A Population-Based Study

2021

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“…Radiological data had been collected from previous studies ([ 56 , 64 , 65 ], Figure 4 ). Briefly, several imaging variables found to be associated with prognosis and/or high-grade histology in a systematic review [ 54 ] were analyzed by a team of two independent observers.…”

Section: Methodsmentioning

confidence: 99%

Occurrence of Fibrotic Tumor Vessels in Grade I Meningiomas Is Strongly Associated with Vessel Density, Expression of VEGF, PlGF, IGFBP-3 and Tumor Recurrence

Heß

Spille

Adeli

et al. 2020

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Angiogenesis is a key feature during oncogenesis and remains a potential target of antiangiogenic therapy. While commonly described in high-grade lesions, vascularization and its correlation with prognosis in grade I meningiomas is largely unexplored. In the histological classification, not only the number but also the composition of blood vessels seems to be important. Therefore, tumor vessel density and fibrosis were correlated with clinical and imaging variables and prognosis in 295 patients with intracranial grade I meningioma. Expression of pro-angiogenic proteins within the meningiomas was investigated by proteome analyses and further validated by immunohistochemical staining. Fibrotic tumor vessels (FTV) were detected in 48% of all tumors and strongly correlated with vessel density, but not with the histopathological tumor subtype. Occurrence of FTV was correlated with a 2-fold increased risk of recurrence in both univariate and multivariate analyses. Explorative proteome analyses revealed upregulation of VEGF (vascular endothelial growth factor), PlGF (placental growth factor), and IGFBP-3 (insulin-like growth factor-binding protein-3) in tumors displaying FTV. Immunohistochemical analyses confirmed strong correlations between tumor vessel fibrosis and expression of VEGF, PlGF, and IGFBP-3. Presence of FTV was strongly associated with disruption of the arachnoid layer on preoperative MRI in univariate and multivariate analyses. In summary, the occurrence of fibrotic tumor vessels in grade I meningiomas is strongly associated with vessel density, disruption of the arachnoid layer, expression of VEGF, PlGF, IGFBP-3 and tumor recurrence.

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“…Several authors have identified GTR as a predictor of prolonged PFS [10,11], while its impact on OS is less clear [10,[12][13][14]. Similarly, advanced age at surgery and bony involvement have been reported to be negative prognostic factors of OS [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Survival in Atypical Meningiomas

Broi

Borrelli

Meling

2021

Cancers

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Introduction: Predictors of survival and progression of disease in atypical meningiomas are less well documented in the literature compared to benign meningiomas. Higher grade meningiomas tend to recur often and one of the most critical aspects is how to best deal with relapses. Methods: A total of 77 consecutive patients who underwent craniotomy for atypical meningioma between 1990–2010 at Oslo University Hospital (OUH) were reviewed. Results: Median age at surgery was 62.21 [interquartile range (IQR): 22.87] years. Fifty-one patients (66.2%) had neurological deficits at presentation. Fifty-four patients (70.1%) underwent gross total resection (GTR). Thirty-nine patients (50.7%) had improved/stable neurological outcomes at 6–12 months. Twenty-two patients (28.6%) underwent retreatment, of whom 20 (26.0%) were subjected to resection followed by adjuvant radiotherapy. Overall survival (OS) was significantly longer in patients <65 years (p < 0.001), with preoperative Karnofsky performance scale (KPS) score of ≥ 70 (p = 0.006), and who required no retreatment (p = 0.033). GTR significantly prolonged the retreatment-free survival rate (p < 0.001). STR carried almost a six-fold greater risk of neurological outcome deterioration (p = 0.044). Conclusions: GTR significantly prolonged retreatment-free survival but had no significant impact on OS. STR was a significant risk factor for deteriorated neurological outcome. Age, preoperative KPS, and retreatment were all strong predictors of OS. Median time-to-retreatment (TTR) did not shorten significantly throughout repeated surgeries.

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Clinical, radiological, and histopathological predictors for long-term prognosis after surgery for atypical meningiomas

Cited by 26 publications

References 40 publications

Clinical Factors and Outcomes of Atypical Meningioma: A Population-Based Study

Clinical Factors and Outcomes of Atypical Meningioma: A Population-Based Study

Occurrence of Fibrotic Tumor Vessels in Grade I Meningiomas Is Strongly Associated with Vessel Density, Expression of VEGF, PlGF, IGFBP-3 and Tumor Recurrence

Predictors of Survival in Atypical Meningiomas

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