Descriptive Epidemiology of World Health Organization Grades II and III Intracranial Meningiomas in the United States

Kshettry, Varun R.; Ostrom, Quinn T.; Kruchko, Carol; Al‐Mefty, Ossama; Barnett, Gene H.; Barnholtz‐Sloan, Jill S.

doi:10.1055/s-0035-1546468

Cited by 21 publications

(34 citation statements)

References 19 publications

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“…As in our previous work, we found that while pediatric meningiomas may include relatively more aggressive subtypes, young age is overall associated with reduced all-cause mortality. 4 In regard to sex, across all ages overall, meningiomas were more frequent in females than in males, but malignancy 19 and mortality 3,20,21 were greater in males than females. Also concordant with previous reports, black race and larger tumor size were found to be adverse prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

“…We report on the meningioma data up to the November 2017 SEER release, but our observational results are broadly consistent with what has been reported in previous epidemiological literature on meningiomas. From 2004 to 2010, Kshettry et al 19 reported that WHO grade II and III meningiomas accounted for 4.2% and 1.2% of newly diagnosed meningiomas, respectively. Likewise, after exclusions, we identified a total of 62,844 meningiomas for the period between 2004 and 2015, of which 4.0% were coded as borderline malignant and 0.9% as malignant.…”

Section: Discussionmentioning

confidence: 99%

“…ICD-O-3 behavior codes were used as WHO grade is not consistently available for meningiomas in SEER. 19,23 Previous studies have used the following correspondence from WHO grade to ICD-O-3 histology and behavior codes: 19,23 We have opted here to display the original ICD-O-3 labels as they are reported in SEER (i.e., /0: benign, /1: borderline malignancy, /3: malignant). All-cause mortality was used in survival analyses because cause-specific mortality is not reliably available across all meningioma cases in SEER.…”

Section: Feature Selectionmentioning

confidence: 99%

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Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

et al. 2020

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Meningiomas are known to have relatively lower aggressiveness and better outcomes than other central nervous system (CNS) tumors. However, there is considerable overlap between clinical and radiological features characterizing benign, atypical, and malignant tumors. In this study, we developed methods and a practical app designed to assist with the diagnosis and prognosis of meningiomas. Statistical learning models were trained and validated on 62,844 patients from the Surveillance, Epidemiology, and End Results database. We used balanced logistic regression-random forest ensemble classifiers and proportional hazards models to learn multivariate patterns of association between malignancy, survival, and a series of basic clinical variables-such as tumor size, location, and surgical procedure. We demonstrate that our models are capable of predicting meaningful individual-specific clinical outcome variables and show good generalizability across 16 SEER registries. A free smartphone and web application is provided for readers to access and test the predictive models (www.meningioma.app). Future model improvements and prospective replication will be necessary to demonstrate true clinical utility. Rather than being used in isolation, we expect that the proposed models will be integrated into larger and more comprehensive models that integrate imaging and molecular biomarkers. Whether for meningiomas or other tumors of the CNS, the power of these methods to make individual-patient predictions could lead to improved diagnosis, patient counseling, and outcomes.npj Digital Medicine (2020) 3:12 ; https://doi.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Feature Selectionmentioning

confidence: 99%

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Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

et al. 2020

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“…In adults, meningiomas are twice as common in females as in males . Histologically, most of the adult meningiomas are WHO grade I (approximately 95%), with grade II and III tumors occurring less frequently (4.2% and 1.2%) …”

Section: Introductionmentioning

confidence: 99%

Clinicopathological and molecular characteristics of pediatric meningiomas

et al. 2017

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Molecular and clinical characteristics of pediatric meningiomas are poorly defined. Therefore, we analyzed clinical, morphological and molecular profiles of pediatric meningiomas. Forty pediatric meningiomas from January 2002 to June 2015 were studied. 1p36, 14q32 and 22q-deletion were assessed by fluorescent in situ hybridization and mutations of most relevant exons of AKT, SMO, KLF4, TRAF and pTERT using sequencing. Expression of GAB1, stathmin, progesterone receptor (PR), p53 along with MIB-1 LI was examined using immunohistochemistry. There were 36 sporadic and four NF2 associated meningiomas. Among sporadic meningiomas, the majority (72.2%) of cases harbored 22q-deletion. Difference in frequency of combined 1p/14q deletion in Grade-I versus Grade-II/III tumors was not significant (13.7% vs 28.5%, P = 0.57). PR immunoreactivity was seen in 65.5% of Grade-I and 14.2% of Grade-II/III tumors (P = 0.03). The majority (97.2%) of meningiomas were immunonegative for p53. Stathmin and GAB co-expression was observed in 58.3% of cases. Notably, AKT, SMO, KLF4, TRAF7 (exon 17) and pTERT mutations were seen in none of the cases analyzed. 1p/14q codeletion was frequent in skull base as compared to non-skull base meningiomas (23% vs 11.1%, P = 0.37). All NF2 meningiomas harbored 22q-deletion and showed GAB and stathmin co-expression while none showed 1p/14q loss. Pediatric meningiomas share certain phenotypic and cytogenetic characteristics with adult counterparts, but GAB and stathmin co-expression in the majority of cases and non-significant difference in frequency of 1p/14q co-deletion between low- and high-grade meningiomas indicate an inherently aggressive nature. Characteristic AKT/SMO, KLF4/TRAF7 and pTERT genetic alterations seen in adults are distinctly absent in pediatric meningiomas.

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“…Brain invasion in the context of otherwise benign histological appearance itself defines the tumour as grade II, thus broadening the inclusion criteria for grade II. Indeed, this has been reflected in the increase in the incidence of grade II and decrease of grade III meningiomas [9]. Backer-Grøndahl et al [1] Despite progressive improvements in the classification of meningiomas, we know from our clinical observations that atypical meningiomas are far from being homogeneous in their natural history and response to treatment.…”

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confidence: 99%

A quest towards personalised medicine for grade II meningiomas—will need to zoom in

2016

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In the end, 206 cases were included in the study and only two patients were lost to follow-up. The median follow-up was 4.1 years, with the interquartile range of 1.6-7.3 years.Overall survival probabilities at 1, 5 and 10 years were respectively: 95, 84 and 73 %-easy numbers to remember. Even based on the relatively low numbers, the 95 %-confidence intervals are fairly tight: 93-98, 78-90, and 65-82 %, respectively. When the 5-year overall survival of the Glasgow cohort is viewed in the context of other series (Table 3) [2], it seems that 5-year survival of surgically treated atypical meningiomas ranges from approximately 75-90 % (an apparent outlier series put aside).Univariate analysis of the cohort revealed age, Simpson grade, presence of brain invasion, venous sinus invasion, tumour volume and reoperation to be associated with survival. These variables were then entered into the Cox multivariate regression model, which identified age (62 years and lower), Simpson resection grade (grades 1-3 versus 4-5) and absence of brain invasion as predictors of longer overall survival.Although questioned by some [14], Simpson grade remains a powerful determinant of prognosis for meningiomas, including atypical meningiomas. In fact, along with our anecdotal observation, Gousias et al. [5] found in their series of 901 consecutive meningioma resections that the influence of Simpson grade on progression-free survival (PFS) was even greater in grade II and III than grade I meningiomas.Radiotherapy was not a factor predictive of survival, even in the univariate model. The specific role of adjuvant radiotherapy for individual tumours remains unclear and has not been rigorously assessed in the existing literature [11,12]. For grade II meningioma, two phase-2 dose-escalation studies by the EORTC and RTOG are due to report soon and the upcoming ROAM/EORTC 1308 trial will address the role of early radiotherapy following gross total resection [6]. Not surprisingly, at least for now, meningiomas remain a Bsurgical^disease with regards to their treatment.Brain invasion was the basis of the last modification of the meningioma grading published in the in the 2007 edition of the WHO classification of the tumours of the central nervous system [10]. In the 1993 classification, when atypical meningioma was first introduced, brain invasion was a feature that automatically upgraded the tumour to an anaplastic category [8]. The next edition, the 2000 WHO classification [7], saw major changes introduced to the grading of meningiomas. The previously vague histological descriptions were tightened up with explicitly defined mitotic rates for each grade. Brain invasion in the context of otherwise benign histological

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Descriptive Epidemiology of World Health Organization Grades II and III Intracranial Meningiomas in the United States

Cited by 21 publications

References 19 publications

Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

Clinicopathological and molecular characteristics of pediatric meningiomas

A quest towards personalised medicine for grade II meningiomas—will need to zoom in

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