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WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment

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Abstract

To analyse the outcome of patients with WHO grade II meningioma and identify factors that may influence recurrence and survival. Between January 2007 and September 2015, a retrospective search identified 194 WHO grade II meningiomas at the National Hospital for Neurology and Neurosurgery, London. Survival methods were implemented. 31 patients (16 %) had a previous history of grade I meningioma. The patients underwent a total of 344 surgical resections and 43.3 % received radiotherapy. 55 patients (28.4 %) had been re-operated on for a WHO grade II meningioma relapse. Median follow-up was 4.4 years. At the end of the study, 75 patients (40.1 %) had no residual tumour on the last scan. Surgical recurrence free survival at 5 years was 71.6, 95 % CI [63.5, 80.8]. Secondary grade II meningioma (HR = 2.29, p = 0.010), and, Simpson resection grade 1, 2 and 3 vs. 4 and 5 (HR = 0.57, p = 0.050) were associated with the surgical recurrence-free survival. 32 died from meningioma (16.5 %). Overall survival probability at 5 years was 83.2, 95 % CI [76.6, 90.4]. Age at diagnosis (HR = 0.22, p < 0.001), WHO grade I meningioma progressing into grade II (HR = 3.2, p = 0.001), tumour location (HR = 0.19, p < 0.001), and mitosis count (HR = 0.36, p = 0.010) were independently associated with the overall survival. Patients who received radiotherapy demonstrated neither a reduced risk of recurrence nor a longer overall survival (p = 0.310). In our series shorter survival correlated with older age, increased mitoses, progression from grade I to II and location. We were not able to demonstrate a significant improvement in any of the clinical outcomes after radiotherapy.

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Abbreviations

CI:

Confidence interval

MGTR:

Macroscopic gross total resection

HPF:

High power field

HR:

Hazard ratio

IQR:

Inter quartile range

MTOR:

Mammalian target of rapamycin

WHO:

World health organization

RT:

Radiotherapy

STR:

Sub total resection

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Acknowledgments

The authors thank the following people for their assistance: Sebastien Brandner, Amanda Leverett, Catherine Mackie, Department of Neuropathology, UCLH, London. Cheong Lee, Department of Neurosurgery, NHNN, London.

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Authors and Affiliations

  1. Victor Horsley Department of Neurosurgical, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London, WC1N 3BG, UK

    Charles Champeaux, Colin Shieff, Akbar Ali Khan & Lewis Thorne

  2. Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK

    Elena Wilson

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  1. Charles Champeaux
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Correspondence to Charles Champeaux.

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Champeaux, C., Wilson, E., Shieff, C. et al. WHO grade II meningioma: a retrospective study for outcome and prognostic factor assessment. J Neurooncol 129, 337–345 (2016). https://doi.org/10.1007/s11060-016-2181-2

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  • DOI: https://doi.org/10.1007/s11060-016-2181-2

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