Skip to main content

Advertisement

SpringerLink
Log in

Atypical and anaplastic meningioma: outcomes in a population based study

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Atypical and anaplastic meningiomas (AAM) are aggressive tumors. This study is aimed at examining associations between patient and tumor-related factors and tumor-related death in patients with AAM. We conducted a population-based cohort study utilizing prospectively collected data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with diagnosis of AAM from 1973 to 2012 in the SEER database were included. Patients lacking clinical information were excluded. Multivariate analysis between patient and lesion characteristics, and AAM-related death was performed to adjust for confounding factors. We identified and included 522 patients in our study. Mean age at diagnosis was 60.8 ± 15.7 years. The majority of patients were White(73%), 15.5% Black, and 9.8% Asian. Average tumor size was 48.2 ± 20.3 mm. The tumor was locally confined in 57.1%, whereas it had intracranial extension in 29.3%, and extracranial extension in 8.8% of patients. The vast majority (94.8%) of tumors were supratentorial. Gross total resection (GTR) was documented in 65.5% of patients. Age at diagnosis (p = 0.001), tumor size (p = 0.003), surgery result (GTR vs. subtotal resection, p = 0.027), and radiation therapy (p = 0.2) were found to be significantly different between the comparison groups. In a multivariate proportional competing risk regression analysis age (HR 1.03, CI [1.01,1.04], p < 0.001), infratentorial location (HR 2.81, CI [1.20, 6.56], p = 0.017), tumor size (HR 1.01, CI [1.00,1.02], p = 0.032),and radiation treatment (HR 1.52, CI [1.11, 2.09], p = 0.01) were significantly associated with tumor-related death. The association of age at diagnosis, tumor size, location, and radiotherapy with overall survival in patients with AAM is demonstrated. The results provide a context for individualized treatment plans in patients with AAM. Additional studies focusing on issues such as the use of radiation and chemotherapy will clarify the best modality to achieve disease control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Dolecek TA, Propp JM, Stroup NE, Kruchko C (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro Oncol 14(5):1–49. doi:10.1093/neuonc/nos218

    Article  Google Scholar 

  2. Kleihues P, Cavenee WK (2000) Pathology and genetics of tumours of the nervous system. International Agency for Research on Cancer, Lyon

    Google Scholar 

  3. Wiemels J, Wrensch M, Claus EB (2010) Epidemiology and etiology of meningioma. J Neurooncol 99:307–314. doi:10.1007/s11060-010-0386-3

    Article  PubMed  PubMed Central  Google Scholar 

  4. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109. doi:10.1007/s00401-007-0243-4

    Article  PubMed  PubMed Central  Google Scholar 

  5. Aizer AA, Bi WL, Kandola MS, Lee EQ, Nayak L, Rinne ML, Norden AD, Beroukhim R, Reardon DA, Wen PY, Al-Mefty O, Arvold ND, Dunn IF, Alexander BM (2015) Extent of resection and overall survival for patients with atypical and malignant meningioma. Cancer 121:4376–4381. doi:10.1002/cncr.29639

    Article  PubMed  Google Scholar 

  6. Hammouche S, Clark S, Wong AH, Eldridge P, Farah JO (2014) Long-term survival analysis of atypical meningiomas: survival rates, prognostic factors, operative and radiotherapy treatment. Acta Neurochir (Wien) 156:1475–1481. doi:10.1007/s00701-014-2156-z

    Article  Google Scholar 

  7. ILin CK, Tsai WC, Lin YC, Hueng DY (2012) Osteopontin predicts the behaviour of atypical meningioma. Histopathology 60:320–325. doi:10.1111/j.1365-2559.2011.04085.x

    Article  Google Scholar 

  8. Lusis EA, Watson MA, Chicoine MR, Lyman M, Roerig P, Reifenberger G, Gutmann DH, Perry A (2005) Integrative genomic analysis identifies NDRG2 as a candidate tumor suppressor gene frequently inactivated in clinically aggressive meningioma. Cancer Res 65:7121–7126. doi:10.1158/0008-5472.CAN-05-0043

    Article  CAS  PubMed  Google Scholar 

  9. Piscevic I, Villa A, Milicevic M, Ilic R, Nikitovic M, Cavallo LM, Grujicic D (2015) The influence of adjuvant radiotherapy in atypical and anaplastic meningiomas: a series of 88 patients in a single institution. World Neurosurg 83:987–995. doi:10.1016/j.wneu.2015.02.021

    Article  PubMed  Google Scholar 

  10. Smith JS, Lal A, Harmon-Smith M, Bollen AW, McDermott MW (2007) Association between absence of epidermal growth factor receptor immunoreactivity and poor prognosis in patients with atypical meningioma. J Neurosurg 106:1034–1040. doi:10.3171/jns.2007.106.6.1034

    Article  CAS  PubMed  Google Scholar 

  11. Sun SQ, Kim AH, Cai C, Murphy RK, DeWees T, Sylvester P, Dacey RG, Grubb RL, Rich KM, Zipfel GJ, Dowling JL, Leuthardt EC, Leonard JR, Evans J, Simpson JR, Robinson CG, Perrin RJ, Huang J, Chicoine MR (2014) Management of atypical cranial meningiomas, part 1: predictors of recurrence and the role of adjuvant radiation after gross total resection. Neurosurgery 75:347–354. doi:10.1227/NEU.0000000000000461

    Article  PubMed  Google Scholar 

  12. Scrucca L, Santucci A, Aversa F (2010) Regression modeling of competing risk using R: an in depth guide for clinicians. Bone Marrow Transplant 45:1388–1395. doi:10.1038/bmt.2009.359

    Article  CAS  PubMed  Google Scholar 

  13. Scrucca L, Santucci A, Aversa F (2007) Competing risk analysis using R: an easy guide for clinicians. Bone Marrow Transplant 40:381–387. doi:10.1038/sj.bmt.1705727

    Article  CAS  PubMed  Google Scholar 

  14. Kuk D, Varadhan R (2013) Model selection in competing risks regression. Stat Med 32:3077–3088. doi:10.1002/sim.5762

    Article  PubMed  Google Scholar 

  15. Fine J, Gray R (1999) A proportional hazards model for the subdistribution of a competing risk. J Amer Statistical Assoc 94:496–509

    Article  Google Scholar 

  16. Buttrick S, Shah AH, Komotar RJ, Ivan ME (2016) Management of atypical and anaplastic meningiomas. Neurosurg Clin N Am 27:239–247. doi:10.1016/j.nec.2015.11.003

    Article  PubMed  Google Scholar 

  17. Zaher A, Abdelbari Mattar M, Zayed DH, Ellatif RA, Ashamallah SA (2013) Atypical meningioma: a study of prognostic factors. World Neurosurg 80:549–553. doi:10.1016/j.wneu.2013.07.001

    Article  PubMed  Google Scholar 

  18. Sade B, Chahlavi A, Krishnaney A, Nagel S, Choi E, Lee JH (2007) World Health Organization grades II and III meningiomas are rare in the cranial base and spine. Neurosurgery 61:1194–1198. doi:10.1227/01.neu.0000306097.38141.65

    Article  PubMed  Google Scholar 

  19. Durand A, Labrousse F, Jouvet A, Bauchet L, Kalamarides M, Menei P, Deruty R, Moreau JJ, Fevre-Montange M, Guyotat J (2009) WHO grade II and III meningiomas:a study of prognostic factors. J Neurooncol 95:367–375. doi:10.1007/s11060-009-9934-0

    Article  PubMed  Google Scholar 

  20. Champeaux C, Dunn L (2016) World Health Organization grade II meningioma. A 10-year retrospective study for recurrence and prognostic factor assessment. World Neurosurg. doi:10.1016/j.wneu.2016.01.055

    Google Scholar 

  21. Hanft S, Canoll P, Bruce JN (2010) A review of malignant meningiomas: diagnosis, characteristics, and treatment. J Neurooncol 99:433–443. doi:10.1007/s11060-010-0348-9

    Article  CAS  PubMed  Google Scholar 

  22. Goyal LK, Suh JH, Mohan DS, Prayson RA, Lee J, Barnett GH (2000) Local control and overall survival in atypical meningioma: a retrospective study. Int J Radiat Oncol Biol Phys 46:57–61

    Article  CAS  PubMed  Google Scholar 

  23. Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW (2008) Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry 79:574–580. doi:10.1136/jnnp.2007.121582

    Article  PubMed  Google Scholar 

  24. Hardesty DA, Wolf AB, Brachman DG, McBride HL, Youssef E, Nakaji P, Porter RW, Smith KA, Spetzler RF, Sanai N (2013) The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection. J Neurosurg 119:475–481. doi:10.3171/2012.12.JNS12414

    Article  PubMed  Google Scholar 

  25. Dziuk TW, Woo S, Butler EB, Thornby J, Grossman R, Dennis WS, Lu H, Carpenter LS, Chiu JK (1998) Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. J Neurooncol 37:177–188

    Article  CAS  PubMed  Google Scholar 

  26. Santacroce A, Walier M, Regis J, Liscak R, Motti E, Lindquist C, Kemeny A, Kitz K, Lippitz B, Martinez Alvarez R, Pedersen PH, Yomo S, Lupidi F, Dominikus K, Blackburn P, Mindermann T, Bundschuh O, van Eck AT, Fimmers R, Horstmann GA (2012) Long-term tumor control of benign intracranial meningiomas after radiosurgery in a series of 4565 patients. Neurosurgery 70:32–39. doi:10.1227/NEU.0b013e31822d408a

    Article  PubMed  Google Scholar 

  27. Pollock BE, Stafford SL, Link MJ (2013) Stereotactic radiosurgery of intracranial meningiomas. Neurosurg Clin N Am 24:499–507. doi:10.1016/j.nec.2013.05.006

    Article  PubMed  Google Scholar 

  28. Jenkinson MD, Waqar M, Farah JO, Farrell M, Barbagallo GM, McManus R, Looby S, Hussey D, Fitzpatrick D, Certo F, Javadpour M (2016) Early adjuvant radiotherapy in the treatment of atypical meningioma. J Clin Neurosci 28:87–92. doi:10.1016/j.jocn.2015.09.021

    Article  PubMed  Google Scholar 

  29. Aizer AA, Arvold ND, Catalano P, Claus EB, Golby AJ, Johnson MD, Al-Mefty O, Wen PY, Reardon DA, Lee EQ, Nayak L, Rinne ML, Beroukhim R, Weiss SE, Ramkissoon SH, Abedalthagafi M, Santagata S, Dunn IF, Alexander BM (2014) Adjuvant radiation therapy, local recurrence, and the need for salvage therapy in atypical meningioma. Neuro Oncol 16:1547–1553. doi:10.1093/neuonc/nou098

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hasan S, Young M, Albert T, Shah AH, Okoye C, Bregy A, Lo SS, Ishkanian F, Komotar RJ (2015) The role of adjuvant radiotherapy after gross total resection of atypical meningiomas. World Neurosurg 83:808–815. doi:10.1016/j.wneu.2014.12.037

    Article  PubMed  Google Scholar 

  31. Palma L, Celli P, Franco C, Cervoni L, Cantore G (1997) Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 86:793–800. doi:10.3171/jns.1997.86.5.0793

    Article  CAS  PubMed  Google Scholar 

  32. Cornelius JF, Slotty PJ, Steiger HJ, Hanggi D, Polivka M, George B (2013) Malignant potential of skull base versus non-skull base meningiomas: clinical series of 1663 cases. Acta Neurochir (Wien) 155:407–413. doi:10.1007/s00701-012-1611-y

    Article  Google Scholar 

  33. Lee SH, Lee EH, Lee SH, Lee YM, Kim HD, Kim YZ (2015) Epigenetic role of histone 3 lysine methyltransferase and demethylase in regulating apoptosis predicting the recurrence of atypical meningioma. J Korean Med Sci 30:1157–1166. doi:10.3346/jkms.2015.30.8.1157

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Vengoechea J, Sloan AE, Chen Y, Guan X, Ostrom QT, Kerstetter A, Capella D, Cohen ML, Wolinsky Y, Devine K, Selman W, Barnett GH, Warnick RE, McPherson C, Chiocca EA, Elder JB, Barnholtz-Sloan JS (2013) Methylation markers of malignant potential in meningiomas. J Neurosurg 119:899–906. doi:10.3171/2013.7.JNS13311

    Article  CAS  PubMed  Google Scholar 

  35. Choy W, Kim W, Nagasawa D, Stramotas S, Yew A, Gopen Q, Parsa AT, Yang I (2011) The molecular genetics and tumor pathogenesis of meningiomas and the future directions of meningioma treatments. Neurosurg Focus 30:E6. doi:10.3171/2011.2.FOCUS1116

    Article  PubMed  Google Scholar 

  36. Du Z, Abedalthagafi M, Aizer AA, McHenry AR, Sun HH, Bray MA, Viramontes O, Machaidze R, Brastianos PK, Reardon DA, Dunn IF, Freeman GJ, Ligon KL, Carpenter AE, Alexander BM, Agar NY, Rodig SJ, Bradshaw EM, Santagata S (2015) Increased expression of the immune modulatory molecule PD-L1 (CD274) in anaplastic meningioma. Oncotarget 6:4704–4716. doi:10.18632/oncotarget.3082

    Article  PubMed  Google Scholar 

  37. Fukami S, Riemenschneider MJ, Kohno M, Steiger HJ (2016) Expression and gene doses changes of the p53-regulator PPM1D in meningiomas: a role in meningioma progression? Brain Tumor Pathol 33:191–199. doi:10.1007/s10014-016-0252-x

    Article  CAS  PubMed  Google Scholar 

  38. Baia GS, Caballero OL, Ho JS, Zhao Q, Cohen T, Binder ZA, Salmasi V, Gallia GL, Quinones-Hinojosa A, Olivi A, Brem H, Burger P, Strausberg RL, Simpson AJ, Eberhart CG, Riggins GJ (2013) NY-ESO-1 expression in meningioma suggests a rationale for new immunotherapeutic approaches. Cancer Immunol Res 1:296–302. doi:10.1158/2326-6066.CIR-13-0029

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115F, Baltimore, MD, 21287, USA

    T. Garzon-Muvdi, W. Yang, M. Lim, H. Brem & J. Huang

Authors
  1. T. Garzon-Muvdi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Brem
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Huang.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 1023 KB)

Supplementary material 2 (DOCX 21 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garzon-Muvdi, T., Yang, W., Lim, M. et al. Atypical and anaplastic meningioma: outcomes in a population based study. J Neurooncol 133, 321–330 (2017). https://doi.org/10.1007/s11060-017-2436-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-017-2436-6

Keywords

Search

Navigation