Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas

Li, De-Pei; Jiang, Pingping; Shijie, Xu; Liu, Cong; Xi, Shaoyan; Zhang, Ji; Chen, Yinsheng; Jiang, Xiaobing; Zhang, Xiangheng; Sai, Ke; Wang, Jian; Mou, Yonggao; Ke, Chao; Chen, Zhongping

doi:10.1007/s11060-019-03278-w

Cited by 34 publications

(15 citation statements)

References 31 publications

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“…Radiotherapy is the only established therapeutic modality for meningiomas beyond surgery, particularly for selected invasive and recurrent meningiomas. 2 , 3 , 20 The strongest independent predictors of tumor recurrence in the Tübingen cohort were WHO grade, the extent of resection and adjuvant radiotherapy. The negative prognostic effect of adjuvant radiotherapy can be explained by the constitution of this distinct subgroup.…”

Section: Discussionmentioning

confidence: 99%

H3K27me3 loss indicates an increased risk of recurrence in the Tübingen meningioma cohort

et al. 2020

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Background A loss of the trimethylation of lysine 27 of histone H3 (H3K27me3) in meningioma has been recently suggested as an adjunct to identify subsets of higher risk of recurrence. The aim of the present study was to assess the prognostic value of H3K27 histone trimethylation and its potential clinical utility in the “Tübingen meningioma cohort”. Methods Patients who underwent meningioma resection between 10/2003 and 1/22015 at the University Hospital Tübingen were included. Immunohistochemical stainings for H3K27me3 and the proliferation marker MIB1 were assessed and correlated with clinical parameters using univariate and multivariate cox regressions as well as Pearson’s chi-squared and log-rank test. Results Overall, 1268 meningiomas were analyzed with a female to male ratio of 2.6 and a mean age of 58.7 years (range 8.3 – 91.0). With 163 cases lost to follow up, 1103 cases were available for further analysis with a mean follow-up of 40.3 months (range 1.1 – 186.3). Male gender, younger age, intracranial tumor localization, progressive tumor, subtotal resection, higher WHO grade, increased MIB1 rate and loss of H3K27me3 were significant negative prognostic factors in the univariate analysis. H3K27me3 status and all other prognostic factors, except age and tumor location, remained significant in the multivariate model. Furthermore, adjuvant radiotherapy was an independent positive prognostic factor. Conclusions Loss of H3K27me3 combined with MIB1 labeling index are independent prognostic factors in meningioma. These data from the Tübingen meningioma cohort support the clinical utility of H3K27me3 immunohistochemical staining in meningioma and its integration into the routine histopathological workup.

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Section: Discussionmentioning

confidence: 99%

H3K27me3 loss indicates an increased risk of recurrence in the Tübingen meningioma cohort

et al. 2020

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“…However, about 20% show a more aggressive behavior with an increased proliferation rate and a higher tendency to recur [3]. Most meningiomas can be treated effectively by surgical excision, while radiation therapy is reserved for selected cases, recurrent tumors and primarily fast-growing subtypes [4][5][6][7]. There are no other established therapy options and especially, more aggressive meningiomas are challenging to treat.…”

Section: Introductionmentioning

confidence: 99%

Brain Invasion in Meningioma—A Prognostic Potential Worth Exploring

Behling

Hempel

Schittenhelm

2021

Cancers

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Most meningiomas are slow growing tumors arising from the arachnoid cap cells and can be cured by surgical resection or radiation therapy in selected cases. However, recurrent and aggressive cases are also quite common and challenging to treat due to no established treatment alternatives. Assessment of the risk of recurrence is therefore of utmost importance and several prognostic clinical and molecular markers have been established. Additionally, the identification of invasive growth of meningioma cells into CNS tissue was demonstrated to lead to a higher risk of recurrence and was therefore integrated into the WHO classification of CNS tumors. However, the evidence for its prognostic impact has been questioned in subsequent studies and its exclusion from the next WHO classification proposed. We were recently able to show the prognostic impact of CNS invasion in a large comprehensive retrospective meningioma cohort including other established prognostic factors. In this review we discuss the growing experiences that have been gained on this matter, with a focus on the currently nonuniform histopathological assessment, imaging characteristics and intraoperative sampling as well as the overall outlook on the future role of this potential prognostic factor.

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“…It may seem obvious that leaving tumor tissue or infiltrated dura behind results in a significant risk of tumor regrowth. However, it remains uncertain where the prognostic role of Simpson grading stands today, especially in light of the established importance of adjuvant radiotherapy for selected cases [2,3,6,13,14] and the recent reclassification of former grade I meningiomas with brain invasion as grade II atypical meningiomas [7]. The aim of this single-center retrospective study was to analyze the prognostic impact of the extent of resection according to the Simpson grading in light of the updated WHO classification together with established prognostic factors and adjuvant radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

The role of Simpson grading in meningiomas after integration of the updated WHO classification and adjuvant radiotherapy

et al. 2020

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Since the introduction of the Simpson grading for the extent of resection in meningiomas in 1957, its usefulness in modern neurosurgery has been challenged. Especially, the updated WHO classification regarding brain invasion and the efficacy of radiation therapy has not been taken into account when evaluating the prognostic role of the Simpson grading in this era. We analyzed the clinical and histopathological data of 1571 meningiomas that were surgically resected in the authors’ institution between July 2003 and March 2017. Operative reports were reviewed regarding the extent of resection according to Simpson grading. Meningioma subtype according to the updated WHO classification of 2016 and clinical characteristics and time to tumor progression were analyzed. The mean follow-up was 38.4 months (range 1.2 to 195.6). A higher rate of tumor recurrence was observed for male gender, younger age, recurrent tumors, non-spinal tumor localization, higher WHO, and Simpson grades in the univariate analysis. In the multivariate analysis older age, recurrent tumors and higher WHO grades remained negative prognostic factors. Among the different Simpson grades, the relative risk for recurrence was highest for grade IV compared to all other grades (each p < 0.0001), while there was no difference between Simpson grades I and II. Adjuvant radiotherapy showed lower rates of tumor recurrence. Subtotal microsurgical resection remains an independent prognostic factor with a higher rate of tumor recurrence. The prognostic benefit of radical treatment of the dural attachment is questionable and needs to be considered when weighing the intraoperative risks of radicality.

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Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas

Cited by 34 publications

References 31 publications

H3K27me3 loss indicates an increased risk of recurrence in the Tübingen meningioma cohort

H3K27me3 loss indicates an increased risk of recurrence in the Tübingen meningioma cohort

Brain Invasion in Meningioma—A Prognostic Potential Worth Exploring

The role of Simpson grading in meningiomas after integration of the updated WHO classification and adjuvant radiotherapy

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