Artikel
Predictors of recurrence following treatment of intracranial meningiomas
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Autoren
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T. Juratli
- Klinik und Poliklinik für Neurochirurgie, Carl Gustav Carus Universitätsklinikum, Dresden
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K. Geiger
- Institut für Pathologie und Neuropathologie, Carl Gustav Carus Universitätsklinikum, Dresden
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C. Mierke
- Klinik und Poliklinik für Neurochirurgie, Carl Gustav Carus Universitätsklinikum, Dresden
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S. Soucek
- Klinik und Poliklinik für Neurochirurgie, Carl Gustav Carus Universitätsklinikum, Dresden
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G. Schackert
- Klinik und Poliklinik für Neurochirurgie, Carl Gustav Carus Universitätsklinikum, Dresden
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M. Kirsch
- Klinik und Poliklinik für Neurochirurgie, Carl Gustav Carus Universitätsklinikum, Dresden
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: To determine risk factors for recurrence after resection of intracranial meningiomas (World Health Organization grade I-III).
Methods: A retrospective study of all patients that underwent a craniotomy for resection of a histologically proven meningioma (WHO Grade I-III) and its recurrence between 1996–2011 were evaluated. Clinical information was retrieved from patient medical records, radiological and immunohistological data. Recurrence analysis was performed using the Kaplan-Meier method. All clinical data, such as neurological outcome, size, extent of resection, as well as tumor specific parameters, such as histological grade, proliferation, and other available immunohistochemical markers (MIB-1, vascular density, EMA, EGFR, VEGFR, PDGFR) were analyzed.
Results: 59 patients with recurrent meningiomas were identified (34 WHO °I, 22 WHO °II and 2 WHO °III). Median follow-up was 45 months. Median time to recurrence was 26 months. The recurrences were matched to a cohort of non-recurrent tumors from the same time period. On uni- and multivariate analyses, only tumor size and location remained significant risk factors for recurrence (p < 0.01). Kaplan-Meier analysis failed to show a significant influence on the recurrence-free survival for all other investigated factors including gender, age, extent of resection (Simpson grade), WHO grade, further malignancies, proliferation index (MIB-1) and EGFR/VEGFR-expression. However, a non-significant tendency toward improved recurrence-free survival after achievement of complete resection in the postoperatively MRI control was seen. 7% of the all patients experienced unwanted complications following surgery, e.g. neurological deficits, CSF leaks or wound healings disturbances.
Conclusions: While gross-total resection of intracranial meningiomas is ideal, our results suggest that there is no significant relationship between the extent of resection (according to Simpson grade) and tumor recurrence. However, meningioma size and location seem to be relevant predictors for recurrence.
