Extent of resection and overall survival for patients with atypical and malignant meningioma

Abstract

BACKGROUND:The prognosis for patients with atypical and malignant meningioma is guarded; whether the extent of resection is associated with survival-based outcomes in this population remains poorly defined. This study investigated the association between gross total resection (GTR) and all-cause mortality in patients with atypical and malignant meningioma. METHODS: The Surveillance, Epidemiology, and End Results program was used to identify 575 and 64 patients betweens the ages of 18 and 70 years who were diagnosed with atypical and malignant meningioma, respectively, between 2004 and 2009. Multivariate Cox proportional hazards regression was used to assess the adjusted impact of GTR versus subtotal resection on all-cause mortality. RESULTS: Baseline patient characteristics were similar for patients who did undergo GTR and patients who did not undergo GTR. The 5-year overall survival rates were 91.3% (95% confidence interval [CI], 86.2%-94.5%) and 78.2% (95% CI, 70.0%-84.3%) for patients with atypical meningioma who did and did not undergo GTR, respectively, and 64.5% (95% CI, 45.9%-78.1%) and 41.1% (95% CI, 17.9%-63.1%) for patients with malignant meningioma who did and did not undergo GTR, respectively. After adjustments for available, pertinent confounding variables, GTR was associated with lower all-cause mortality in patients with atypical (hazard ratio, 0.39; 95% CI, 0.23-0.67; P <.001) and malignant meningioma (hazard ratio, 0.35; 95% CI, 0.15-0.81; P 5.01). CONCLUSIONS: The extent of resection is a powerful predictor of outcome for patients with atypical and malignant meningioma. These data highlight the hazard associated with the presence of gross tumor bulk after surgery and suggest a value for more extensive resections that should be balanced against the additional potential morbidity. Cancer 2015;121:4376-81.

Atypical and anaplastic meningioma: outcomes in a population based study

“…This effect was abrogated at older ages suggesting differences in tumor behavior or potential invasion of adjacent critical structures [16,19,21,22]. In addition to tumor size, extent of surgical resection is one of the most important prognostic factors for recurrence and survival in patients with atypical and anaplastic meningiomas [5,19,[22][23][24][25].…”

“…Some of these characteristics include genetic abnormalities, extent of surgical resection, need for adjuvant radiation, and histological features such as mitotic rates; however, most of these factors have not been verified in a large cohort [5][6][7][8][9][10][11].…”

Review of controversies in management of non-benign meningioma

“…Overall survival (OS) data was not given in all of the reports. However, in a recent review of the Surveillance, Epidemiology and End Results (SEER) database, patients who had undergone GTR of a Grade II meningioma had an overall 5-year survival of 91.3%, compared to 78.2% in a similar group of patients who had STR of their meningioma [24].…”

“…In the SEER review described earlier for Grade II meningiomas, the effect of EOR on OS was also evaluated in MM [24]. 5-year OS was 64.5% in patients who underwent GTR of their MM.…”

Predictors of early progression of surgically treated atypical meningiomas

“…[1] Nevertheless, atypical meningiomas, which account for 20–35% of all meningiomas, have recurrence rates up to 50% and 10-year survival less than 80%. [2–4]…”