Artikel
Outcome and survival following surgery on primary and secondary malignant 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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M. Kirsch
- 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
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Malignant meningiomas World Health Organization (WHO) Grade III are rare extraaxial tumors. Malignant meningiomas may arise from low-grade meningiomas grade I or II (secondary malignant meningiomas) or develop as de novo primary malignant meningiomas. In this study, we analyzed in a retrospective single center series clinical factors influencing progression-free and overall survival following treatment of primary and secondary malignant meningiomas.
Methods: All patients undergoing craniotomy for resection of a histologically proven meningioma (WHO Grade III) between 1995 and 2010 were evaluated. We analyzed clinical, radiological and immunohistological data from these patients. Furthermore, we performed Kaplan-Meier and Cox regression analyses to determine the impact of different clinical characteristics and different treatment modalities on survival and malignization for these lesions.
Results: We identified 16 patients with malignant meningiomas of a total of 843 meningiomas, treated in our department. Seven patients had a secondary meningioma and nine patients a primary one. The median clinical follow-up time was 8 years (range 1–13 years). All patients with malignant meningiomas received radiotherapy, three of them received an adjuvant chemotherapy. The median overall survival rates for secondary and primary malignant meningiomas following the confirmation of histological malignizations were 6 and 10 years respectively (p < 0.05). Kaplan-Meier analysis demonstrated a marked survival benefit through repeated operations in both groups in respect to the extent of resection (p < 0.05). Further investigated factors, including gender, age, proliferation index (MIB-1), vascular density and EGFR/VEGFR-expression, failed to show a significant influence on the overall survival (p > 0.05).
Conclusions: Surgery is an effective treatment for secondary and primary WHO Grade III meningiomas at appearance and recurrence. In addition, repeated surgery was the only identified significant prognostic factor for improved PFS and OS. However, secondary malignant meningiomas seem to be of more aggressive nature than primary ones with a higher risk toward recurrence and with a significantly reduced survival time.
