Predictors of Treatment Response and Survival Outcomes in Meningioma Recurrence with Atypical or Anaplastic Histology

Chohan, Muhammad Omar; Ryan, Christopher T.; Singh, Ranjodh; Lanning, Ryan M.; Reiner, Anne S.; Rosenblum, Marc K.; Tabar, Viviane; Gutin, Philip H.

doi:10.1093/neuros/nyx312

Cited by 34 publications

(23 citation statements)

References 69 publications

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“…A competitive risk regression model was used to analyze the predictors of second recurrence. These authors suggested increasing radiation therapy to better control the tumor and challenged the importance of the extent of resection in the first recurrence ( 32 ). Both above-described studies built a model and predicted the recurrence of meningiomas; however, compared to our study, these two previous studies included fewer patients, focused only on the risk factors and did not further quantify or classify the results.…”

Section: Discussionmentioning

confidence: 99%

A Quantified Risk-Scoring System for the Recurrence of Meningiomas: Results From a Retrospective Study of 392 Patients

Zhu

Wang

et al. 2020

Front. Oncol.

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Aim: This study aimed to identify the independent risk factors of recurrence in patients undergoing primary resection of meningioma and construct a scoring system for the prediction of the risk of postoperative recurrence. Materials and Methods: The clinical data of 591 patients who underwent primary surgical resection for meningioma at the First Affiliated Hospital of Wenzhou Medical University between November 2010 and December 2016 were retrospectively reviewed. The clinical, radiological, and pathological characteristics were evaluated, and the independent risk factors for recurrence were identified via receiver operating characteristic (ROC) curve and logistic analyses. A scoring system that included these independent risk factors was used to construct a risk-predicting model that was evaluated via a ROC curve analysis. The recurrences of different subgroups were observed by Kaplan-Meier's curves. Results: The clinical data of 392 patients with meningioma were used to construct the scoring system. The logistic analysis showed that sex (OR = 2.793, 95% CI = 1.076–7.249, P = 0.035), heterogeneous tumor enhancement (OR = 4.452, 95% CI = 1.714–11.559, P = 0.002), brain invasion (OR = 2.650, 95% CI = 1.043–6.733, P = 0.041), Simpson's removal grade (OR = 5.139, 95% CI = 1.355–19.489, P = 0.016), and pathological grade (OR = 3.282, 95% CI = 1.123–9.595, P = 0.030) were independent risk factors for recurrence. A scoring system was developed and used to divide the patients into the following four subgroups: subgroup 1 with scores of 0–75 ( n = 249), subgroup 2 with scores of 76–154 ( n = 88), subgroup 3 with scores of 155–215 ( n = 46), and subgroup 4 with scores of 216–275 ( n = 9). The incidences of recurrence in each subgroup were as follows: subgroup 1, 1.2%; subgroup 2, 5.7%; subgroup 3, 26.1%; and subgroup 4, 66.7% ( P < 0.001). The scoring system reliably predicted the postoperative recurrence of meningioma with a high area under the ROC curve. Conclusions: Our scoring system is a simple and reliable instrument for identifying meningioma patients at risk of postoperative recurrence and could help in optimizing individualized clinical treatment.

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Section: Discussionmentioning

confidence: 99%

A Quantified Risk-Scoring System for the Recurrence of Meningiomas: Results From a Retrospective Study of 392 Patients

Zhu

Wang

et al. 2020

Front. Oncol.

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“…Moreover, in patients with recurrent high‐grade meningioma, Cox regression analysis failed to identify any factor with significant association with either PFS or OS. However, the result from another retrospective study suggested better tumor control with the addition of radiation for patients with recurrent high‐grade meningioma . Thus, a larger cohort or multicenter clinical trial is needed to investigate the effect of radiation in this subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…However, the result from another retrospective study suggested better tumor control with the addition of radiation for patients with recurrent high-grade meningioma. 21 Thus, a larger cohort or multicenter clinical trial is needed to investigate the effect of radiation in this subgroup. Adjuvant radiotherapy is generally recommended for patients with primary high-grade meningioma after incomplete resection, 6,7,10,22 with isolated reports suggesting that postoperative stereotactic radiosurgery is not associated with a statistically significant PFS benefit for patients with atypical meningioma following STR.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of adjuvant radiotherapy for atypical and anaplastic meningioma

Zhu

Aizer

et al. 2019

Cancer Medicine

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The effect of adjuvant radiotherapy in management for high‐grade meningiomas, especially atypical meningiomas, remains controversial. We aimed to explore the role of adjuvant radiotherapy in this population. A total of 162 adults with high‐grade meningiomas (99 atypical meningiomas and 63 anaplastic meningiomas) were treated from 2003 to 2008 at Huashan Hospital. One hundred and seventeen patients presented with primary and 45 with recurrent disease. One hundred and fifteen patients (70.9%) were treated with adjuvant radiotherapy after surgical resection. The median follow‐up was 76.5 months (range 1‐142 months). Kaplan‐Meier survival curve and Cox proportional hazards modeling were used for analyses. Adjuvant radiotherapy was associated with prolonged progression‐free survival (PFS) and overall survival (OS) in patients with newly diagnosed anaplastic meningiomas irrespective of extent of resection (PFS, P = .001; OS, P = .003). Gross total resection was the only independent prognostic factor for those with newly diagnosed atypical meningiomas (PFS, P < .001; OS, P = .012). A survival benefit for adjuvant radiation was also found in subgroup analysis of patients with high‐grade meningiomas who underwent subtotal resection (PFS, P = .023; OS, P = .013). Among recurrent high‐grade meningiomas, radiotherapy offered no statistically significant improvement in either PFS or OS. Adjuvant radiotherapy is associated with improved survival in patients with newly diagnosed anaplastic meningiomas and those high‐grade meningiomas following subtotal resection. However, there was no significant correlation identified between postoperative radiation and outcome for recurrent high‐grade meningiomas. Future prospective randomized trials may help clarify the optimal tailored treatment for patients with high‐grade meningioma.

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“…There have been a number of reports looking into factors associated with progression-free survival with multiple factors being implicated. Location, [ 10 , 32 ] extent of resection, [ 15 , 17 , 20 , 33 – 35 ] presence of atypia, [ 36 ] brain invasion, [ 23 , 26 , 37 , 38 ] high MI, [ 26 , 37 – 39 ] high MIB1 labelling, [ 15 , 17 , 33 , 39 ] bone involvement, [ 19 , 23 , 37 ] use of adjuvant radiotherapy [ 9 , 40 – 42 ] and secondary progression from WHO I tumour. [ 30 ] However, others have shown that none of the above factors influence the recurrence rate or time to recurrence of atypical meningioma.…”

Section: Discussionmentioning

confidence: 99%

Predictors of early progression of surgically treated atypical meningiomas

et al. 2018

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BackgroundClinical behaviour of atypical meningiomas is not uniform. While, as a group, they exhibit a high recurrence rate, some pursue a more benign course, whereas others progress early. We aim to investigate the imaging and pathological factors that predict risk of early tumour progression and to determine whether early progression is related to outcome.MethodsAdult patients with WHO grade II meningioma treated in three regional referral centres between 2007 and 2014 were included. MRI and pathology characteristics were assessed. Gross total resection (GTR) was defined as Simpson 1–3. Recurrence was classified into early and late (≤ 24 vs. > 24 months).ResultsAmong the 220 cases, 37 (16.8%) patients progressed within 24 months of operation. Independent predictors of early progression were subtotal resection (STR) (p = 0.005), parafalcine/parasagittal location (p = 0.015), peritumoural oedema (p = 0.027) and mitotic index (MI) > 7 (p = 0.007). Adjuvant radiotherapy was negatively associated with early recurrence (p = 0.046). Thirty-two per cent of patients with residual tumour and 26% after GTR received adjuvant radiotherapy. There was a significantly lower proportion of favourable outcomes at last follow-up (mRS 0–1) in patients with early recurrence (p = 0.001).ConclusionsAtypical meningiomas are a heterogeneous group of tumours with 16.8% patients having recurrence within 24 months of surgery. Residual tumour, parafalcine/parasagittal location, peritumoural oedema and a MI > 7 were all independently associated with early recurrence. As administration of adjuvant radiotherapy was not protocolised in this cohort, any conclusions about benefits of irradiation of WHO grade II meningiomas should be viewed with caution. Patients with early recurrence had worse neurological outcome. While histological and imaging characteristics provide some prognostic value, further molecular characterisation of atypical meningiomas is warranted to aid clinical decision making.

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Predictors of Treatment Response and Survival Outcomes in Meningioma Recurrence with Atypical or Anaplastic Histology

Cited by 34 publications

References 69 publications

A Quantified Risk-Scoring System for the Recurrence of Meningiomas: Results From a Retrospective Study of 392 Patients

A Quantified Risk-Scoring System for the Recurrence of Meningiomas: Results From a Retrospective Study of 392 Patients

Efficacy of adjuvant radiotherapy for atypical and anaplastic meningioma

Predictors of early progression of surgically treated atypical meningiomas

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