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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Clinical, radiological and histopathological predictors for long-term prognosis after surgery for atypical meningiomas

Klinische, radiologische und histopathologische Prädiktoren für die postoperative Langzeitprognose von atypischen Meningiomen

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  • presenting/speaker Eileen Maria Susanne Streckert - Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
  • Katharina Heß - Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
  • Peter B. Sporns - Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
  • Alborz Adeli - Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
  • presenting/speaker Caroline Brokinkel - Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
  • Jan Kriz - Universitätsklinikum Münster, Klinik für Strahlentherapie und Radioonkologie, Münster, Deutschland
  • Markus Holling - Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
  • Hans Theodor Eich - Universitätsklinikum Münster, Klinik für Strahlentherapie und Radioonkologie, Münster, Deutschland
  • Werner Paulus - Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
  • Dorothee Cäcilia Spille - Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
  • Albertus TCJ van Eck - Gamma Knife Zentrum Krefeld, Krefeld, Deutschland
  • David R. Raleigh - University of California San Francisco, Department of Radiation Oncology, San Francisco, CA, United States
  • Michael W. McDermott - University of California San Francisco, Department of Neurological Surgery, San Francisco, CA, United States
  • Walter Stummer - Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
  • presenting/speaker Benjamin Brokinkel - Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP170

doi: 10.3205/20dgnc453, urn:nbn:de:0183-20dgnc4534

Published: June 26, 2020

© 2020 Streckert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Although considerable rates of recurrence and mortality can be found in atypical meningiomas, reliable predictors for evaluating a long-term prognosis are unclear. On the other hand, determinations of molecular alterations known to correlate with recurrence have not yet been established in routine neuropathological analyses. Therefore, we aimed to determine clinical, radiological and histological risk factors for progression available from routine perioperative data.

Methods: Associations of radiological, clinical and histological variables with recurrence and mortality were retrospectively analyzed by uni- and multivariate analyses.

Results: 138 patients consisting of 64 females and 74 males (46% and 54%, median age 62 years) underwent surgery for intracranial atypical meningioma between 1991 and 2018 were included. Gross total resection (GTR, Simpson grade I+II) could be achieved in 81% of all cases, whereas subtotal resection (STR, Simpson grade ≥III) was achieved in 19%. Within a median follow-up of 62 months, recurrence occurred in 52 (38%) and death in 22 (16%) cases. In patients who did not receive adjuvant irradiation, recurrence rates were higher after STR than after GTR (32% vs 63%, p=.025). In univariate analyses, only intra-tumoral calcifications on preoperative MRI (p=.012) and the presence of brain invasion in the absence of other histological grading criteria (p=.010) were correlated with recurrence. In multivariate analyses, only patient age was positively (HR: 1.03, 95%CI 1.04-1.05; p=.018), and the presence of brain invasion as the only grading criterion (HR: .37, 95%CI .19-.74; p=.005) was negatively associated with progression, while increasing age at the time of surgery (HR: 1.07, 95%CI 1.03-1.12; p=.001) was prognostic for mortality.

Conclusion: Reliable clinical predictors for both progression and mortality in patients with atypical meningiomas are difficult to determine. However, both gross total resection and, after STR, adjuvant irradiation might improve local tumor control rates. PFI was longer in brain-invasive but otherwise histologicalyl benign meningiomas and in tumors displaying calcifications on preoperative MRI.