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Microscopic brain invasion in meningiomas previously classified as WHO grade I is not associated with patient outcome

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Abstract

Purpose

For meningiomas, the 2016 revision of the WHO classification introduced brain invasion per se as a sufficient condition to classify as grade II. We analyzed whether meningiomas previously graded as WHO grade I differ in prognosis depending on the presence of microscopic brain invasion.

Methods

A consecutive series of patients with intracranial meningioma WHO grade I (± brain invasion) at two neurosurgical departments was analyzed retrospectively. Cox regression models on progression-free survival (PFS) and Kaplan–Meier survival estimates were performed.

Results

875 adult patients were included. Histological diagnosis of brain invasion was confirmed in 28 patients. Median follow-up was 73 months. In univariate and multivariate models, gross total resection gained favorable prognostic influence for PFS (p < 0.001, HR: 0.237, CI 0.170–0.382). 170 patients with the brain/meningioma interface present in histopathological specimen were separately analyzed as a subgroup. Importantly, presence of brain invasion did not reach significance for PFS, even in the subgroup with available specimen of brain/meningioma interface (p = 0.787, HR: 0.852, CI 0.268–2.710 and p = 0.811, HR: 0.848, CI 0.222–3.246, respectively). Patients with and without brain invasion did not differ in terms of age, tumor location and extent of resection, but were more likely to receive radiotherapy (p = 0.03) of tumor remnants. However, subgroup analysis of non-irradiated tumors revealed no prognostic influence of brain invasion (p = 0.749, HR: 0.772, CI 0.158–3.767).

Conclusions

In this bi-institutional series, brain invasion was frequent among meningiomas WHO grade I when brain/meningioma interface was available for histology (16.5%). However, brain invasion did not impact early recurrence.

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Acknowledgements

The authors would like to thank Mandy Barthel and Raffaela Vitalini for review of patient data.

Funding

None.

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Author notes

  1. Annamaria Biczok and Christine Jungk have contributed equally.

Authors and Affiliations

  1. Department of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    Annamaria Biczok, Bogdana Suchorska, Joerg C. Tonn & Christian Schichor

  2. Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany

    Rupert Egensperger

  3. German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany

    Annamaria Biczok, Christine Jungk, Rupert Egensperger, Andreas von Deimling, Bogdana Suchorska, Joerg C. Tonn, Christel Herold-Mende & Christian Schichor

  4. Department of Neurosurgery, University Hospital, Heidelberg, Germany

    Christine Jungk & Christel Herold-Mende

  5. Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany

    Andreas von Deimling

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  1. Annamaria Biczok
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  2. Christine Jungk
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Contributions

Development of study concept: AB, CJ, JCT, CS; Composition of manuscript: AB, CJ, JCT, CS; Review of histologic specimen: RE, AVD; Statistical analysis: AB, BS.

Corresponding author

Correspondence to Annamaria Biczok.

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The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Ethical approval

The study was approved by the ethic committees of Ludwig-Maximilians University (Approval Number: 18–837) and Ruprecht-Karls University (Approval Number: S-005/2003)

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Informed consent was obtained from all patients.

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Biczok, A., Jungk, C., Egensperger, R. et al. Microscopic brain invasion in meningiomas previously classified as WHO grade I is not associated with patient outcome. J Neurooncol 145, 469–477 (2019). https://doi.org/10.1007/s11060-019-03312-x

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  • DOI: https://doi.org/10.1007/s11060-019-03312-x

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