Intracranial Meningiomas, WHO Grade Il : Prognostic Implications of Clinicopathologic Features

To analyse the outcome of patients with WHO grade II meningioma and identify factors that may influence recurrence and survival. Between January 2007 and September 2015, a retrospective search identified 194 WHO grade II meningiomas at the National Hospital for Neurology and Neurosurgery, London. Survival methods were implemented. 31 patients (16 %) had a previous history of grade I meningioma. The patients underwent a total of 344 surgical resections and 43.3 % received radiotherapy. 55 patients (28.4 %) had been re-operated on for a WHO grade II meningioma relapse. Median follow-up was 4.4 years. At the end of the study, 75 patients (40.1 %) had no residual tumour on the last scan. Surgical recurrence free survival at 5 years was 71.6, 95 % CI [63.5, 80.8]. Secondary grade II meningioma (HR = 2.29, p = 0.010), and, Simpson resection grade 1, 2 and 3 vs. 4 and 5 (HR = 0.57, p = 0.050) were associated with the surgical recurrence-free survival. 32 died from meningioma (16.5 %). Overall survival probability at 5 years was 83.2, 95 % CI [76.6, 90.4]. Age at diagnosis (HR = 0.22, p < 0.001), WHO grade I meningioma progressing into grade II (HR = 3.2, p = 0.001), tumour location (HR = 0.19, p < 0.001), and mitosis count (HR = 0.36, p = 0.010) were independently associated with the overall survival. Patients who received radiotherapy demonstrated neither a reduced risk of recurrence nor a longer overall survival (p = 0.310). In our series shorter survival correlated with older age, increased mitoses, progression from grade I to II and location. We were not able to demonstrate a significant improvement in any of the clinical outcomes after radiotherapy.

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“…grade II. MGTR is associated with better local control than incomplete resection [11,[20][21][22][23].…”

Section: Resultsmentioning

confidence: 99%

WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment

et al. 2016

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“…Clinically, recurrence rates vary between studies, depending on both the duration of follow-up and the number of patients studied. An analysis of some of these studies has shown that the patient's age at diagnosis, 20 complete resection or GTR, 30 and postoperative radiotherapy 20,33 are invariably associated with lower risks of atypical meningioma recurrence.…”

Section: Discussionmentioning

confidence: 99%

Results of immunohistochemical staining for cell cycle regulators predict the recurrence of atypical meningiomas

Kim¹,

Kim²,

Lee

et al. 2014

JNS

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Object The aim of this study was to evaluate the role of certain cell-cycle regulatory proteins in the recurrence of atypical meningiomas. These proteins were analyzed with immunohistochemical staining to identify predisposing factors for the recurrence of atypical meningiomas. Methods The authors retrospectively reviewed the medical records of patients with atypical meningiomas diagnosed in the period from January 2000 to June 2012 at the Department of Neurosurgery at Samsung Changwon Hospital and Dong-A University Medical Center. Clinical data included patient sex and age at the time of surgery, presenting symptoms at diagnosis, location and size of tumor, extent of surgery, use of postoperative radiotherapy, duration of follow-up, and recurrence. Immunohistochemical staining for cell-cycle regulatory proteins (p16, p15, p21, p27, cyclin-dependent kinase [CDK] 4 and 6, phosphorylated retinoblastoma [pRB] protein, and cyclin D1) and proliferative markers (MIB-1 antigen, mitosis, and p53) was performed on archived paraffin-embedded tissues obtained during resection. The recurrence rate and time to recurrence were assessed using Kaplan-Meier analysis. Results Of the 67 atypical meningiomas eligible for analysis, 26 (38.8%) recurred during the follow-up period (mean duration 47.7 months, range 8.4–132.1 months). Immunohistochemically, there was overstaining for p16 in 44 samples (65.7%), for p15 in 21 samples (31.3%), for p21 in 25 samples (37.3%), for p27 in 32 samples (47.8%), for CDK4 in 38 samples (56.7%), for CDK6 in 26 samples (38.8%), for pRB protein in 42 samples (62.7%), and for cyclin D1 in 49 samples (73.1%). Multivariate analysis using the Cox proportional-hazards regression model showed that incomplete resection (HR 4.513, p < 0.001); immunohistochemical understaining for p16 (HR 3.214, p < 0.001); immunohistochemical overstaining for CDK6 (HR 3.427, p < 0.001), pRB protein (HR 2.854, p = 0.008), and p53 (HR 2.296, p = 0.040); and increased MIB-1 labeling index (HR 2.665, p = 0.013) and mitotic index (HR 2.438, p = 0.024) predicted the recurrence of atypical meningiomas after resection. Conclusions Findings in this study indicated that p16, CDK6, and pRB protein were associated with the recurrence of atypical meningiomas.

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“…Our cases' age range was wide differing from 22 to 75, but mean age was 55.8±50 years and a slight female predominance of 69% was obtained similar with the literature (Greenberg, 2001;Yılmaz, et al, 2012). Moon et al (2012), evaluated prognostic factors of WHO Grade II meningiomas and found out that the patients had a median age of 48.4 years and similar to our study group there has been slight female predominance with 29/26: Female/male in their series. In a study conducted by Mahmood et al (1993), typical and malign meningiomas were observed in males more often than females.…”

Section: Discussionmentioning

confidence: 99%

Intracranial meningiomas: Two-years experience of Mustafa Kemal University

Özgür¹,

Altaş²,

Aras³

et al. 2013

jecm

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Article HistoryReceived 11 / 01 / 2013 Accepted 09 / 02 / 2013Meningiomas are the most common type of brain tumors. We have analyzed clinical, radiological and pathological characteristics of meningiomas that were diagnosed and operated in our centre. Twenty three meningioma cases operated in our hospital between 2010-2012 were reviewed retrospectively. Sixteen (69.1%) of cases were female and 7 (30.9%) of cases were male. The age range was 22-75. The most common symptoms of patients were headache, seizure, nausea and vomitting. Localizations of tumors were falx, cortex, sphenoid wing, posterior fossa-tentorium, olphactor, and sulcus. The surgical sizes were graded according to Simpson classification and 16 (69.1%) of cases were Grade 2 and 7 (30.9%) of cases were Grade I. At the histopathological examination; meningotheliomatous type was the most common type followed by fibrous, angiomatous, transitional, psammomatous and atypical types. Meningiomas are usually benign tumors with good prognosis which are often encountered in daily pathology and neurosurgery practice.

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Intracranial Meningiomas, WHO Grade Il : Prognostic Implications of Clinicopathologic Features

Cited by 22 publications

References 21 publications

WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment

WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment

Results of immunohistochemical staining for cell cycle regulators predict the recurrence of atypical meningiomas

Intracranial meningiomas: Two-years experience of Mustafa Kemal University

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