A comparison of World Health Organization tumor grades at recurrence in patients with non–skull base and skull base meningiomas

Clinical article

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Object

Despite a favorable outcome for most patients with WHO Grade I meningiomas, a subset of these patients will have recurrent or progressive disease that advances to a higher grade and requires increasingly aggressive therapy. The goal of this study was to identify clinical characteristics associated with the recurrence of benign meningiomas and their acceleration to atypical and malignant histological types.

Methods

Records of 216 patients with WHO Grade I, II, or III meningioma that were initially treated between 1965 and 2001 were retrospectively reviewed. Median follow-up was 7.2 years.

Results

Patients with non–skull base cranial meningiomas (82 of 105 [78%]) were more likely to have undergone a gross-total resection than patients with skull base meningiomas (32 of 78 [41%]; p < 0.001). Consequently, patients with Grade I non–skull base cranial meningiomas had better 5-year recurrence-free survival (69%) than patients with Grade I skull base meningiomas (56%) or Grade II or III tumors at any site (50%; p = 0.005). Unexpectedly, patients with non–skull base tumors who experienced a recurrence (8 of 22 [36%]) were more likely than patients with skull base tumors (1 of 19 [5%]) to have a higher grade tumor at recurrence (p = 0.024). Furthermore, the median MIB-1 labeling index of Grade I non–skull base cranial meningiomas (2.60%) was significantly higher than that of Grade I skull base tumors (1.35%; p = 0.016).

Conclusions

Cranial meningiomas that occur outside of the skull base are more likely to have a higher MIB-1 labeling index and recur with a higher grade than those within the skull base, suggesting that non–skull base cranial tumors may have a more aggressive biology than skull base tumors.

Abbreviations used in this paper: GTR = gross-total resection; HR = hazard ratio; RFS = recurrence-free survival; STR = subtotal resection.

Article Information

Address correspondence to: Shiao Y. Woo, M.D., The University of Texas M. D. Anderson Cancer Center, Department of Radiation Oncology, 1515 Holcombe Boulevard, Box 1150, Houston, Texas 77030. email: SYWoo@mdanderson.org.

Please include this information when citing this paper: published online October 2, 2009; DOI: 10.3171/2009.9.JNS09617.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graph of RFS rates from 124 patients initially undergoing a GTR alone, 56 undergoing an STR alone, and 13 who underwent an STR followed by radiation therapy (STR + XRT).

  • View in gallery

    Graphs of RFS rates from patients with cranial, non–skull base meningiomas (A) and skull base meningiomas (B). A: Recurrence-free survival in 80 patients who initially underwent a GTR, in 19 who underwent an STR alone, and in 4 who underwent STR followed by radiation therapy (STR + XRT). B: Recurrence-free survival in 32 patients who initially underwent GTR alone, in 37 who underwent STR alone, and in 9 who underwent STR followed by radiation therapy.

  • View in gallery

    Graph of RFS rates from 93 patients with cranial meningiomas initially presenting with a Grade I tumor outside of the skull base, 71 presenting with a Grade I tumor in the skull base, and 24 presenting with a Grade II or III tumor at any location.

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