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Clinical features, surgical management, and prognostic factors of secretory meningiomas: a single-center case series of 149 patients

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Abstract

Secretory meningioma (SM) is a rare histological subtype of the meningioma family. Few reports investigating SM have been published due to its extremely low incidence; thus, the current understanding of this disease is poor. We analyzed the incidence and clinical, radiological, pathological, and prognostic features of SM. Approximately 12,380 intracranial meningiomas were surgically resected at Beijing Tiantan Hospital between April 2008 and January 2017. All pathologically confirmed SM cases were identified. SMs accounted for approximately 1.2% of the intracranial meningiomas (149 of 12,380). The patients with SM had a mean age of 51.0 years and were predominantly female (112 female and 37 male). Radiologically, peritumoral brain edema was observed in 49 (32.9%) patients. Gross total resection was achieved in 115 (77.2%) cases. At the 35-months median follow-up (range 4–109 months), six patients had tumor recurrence, and one patient died from the tumor recurrence. The 5-year progression-free survival rates were 95.9%, and the 5-year overall survival rate was 99.3%. A skull base location and a tumor size ≥ 3.5 cm were significantly associated with poor short-term outcomes, and a skull base location was significantly associated with an increased risk of poor long-term outcomes (P < 0.05). A skull base location (OR 3.797; 95% CI 1.071–13.468; P = 0.039) and tumor size ≥ 3.5 cm (OR 2.616; 95% CI 1.107–6.181; P = 0.028) were independent risk factors for non-gross total resection. A son-skull base location (OR 0.070; 95% CI 0.028–0.177; P = 0.001) was the only independent risk factor that correlated with more severe peritumoral brain edema. SM is a rare subtype of meningiomas with a female predominance and low recurrence. Our results highlight the risk factors for short- and long-term outcomes, which can be useful for selecting treatments and predicting prognosis. Microsurgical treatment of a skull base SM remains a formidable challenge due to a large tumor size and critical neurovascular structure encasement.

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Acknowledgements

We would like to thank all the patients who trusted us and all the physicians and staff who helped this study.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China

    Xiaogang Tao, Jinqian Dong, Zonggang Hou, Zhen Wu, Junting Zhang & Baiyun Liu

  2. Department of Neurosurgery, Qingdao Huangdao district People’s Hospital, Qingdao, 266400, Shandong, China

    Kun Wang

  3. Department of Neurotrauma, Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100050, China

    Baiyun Liu

  4. Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Beijing, 100050, China

    Baiyun Liu

  5. China National Clinical Research Center for Neurological Diseases, Beijing, 100050, China

    Baiyun Liu

  6. Beijing Key Laboratory of Central Nervous System Injury, Beijing, 100050, China

    Baiyun Liu

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  1. Xiaogang Tao
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  2. Kun Wang
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  3. Jinqian Dong
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Correspondence to Baiyun Liu.

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings described in this paper.

Ethical standards

This retrospective study was approved by Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Electronic supplementary material

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11060_2017_2671_MOESM1_ESM.tif

Supplementary Fig. 1. Radiologic presentation and quantification of peritumoral edema formation in SM. CT and MRI of a representative SM case, pressing on the right temporal lobe with extensive perifocal edema and pronounced midline shift. Plain CT scan (A), plain T1-weighted (B) and T2-weighted (C) MR images, and ADC images (D) depict widespread edema of the white matter. (E) Comparison of peritumoral edema formation for skull base and non-skull base tumors using Regelsberger Score [&#x003C;link rid="bib16"&#x003E;16&#x003C;/link&#x003E;]. (F) Comparison of tumor location for peritumoral tumor edema and non-edema (TIF 705 KB)

11060_2017_2671_MOESM2_ESM.tif

Supplementary Fig. 2. Four cases with respective grade 0 to 3 peritumoral brain edema, manifested by axial T2 weighted images. A: grade 0 (cases 31); B: grade 1 (cases 85); C: grade 2 (cases 72); D: grade 3 (cases 63) (TIF 1988 KB)

Supplementary Fig. 3. Kaplan–Meier plots of PFS and OS for 149 patients with SM (TIF 113 KB)

11060_2017_2671_MOESM4_ESM.tif

Supplementary Fig. 4. Pathological features of SM. Histological section showed typical focal epithelial differentiation, glandular lumina containing secretory globules, and pseudopsammoma bodies (A, B and C). In the immunohistochemical analysis, tumor cells were positive for CEA (D), EMA (E), CK (F) and vimentin (G). Original magnification in (A, C-G) is 200 ×. (B) is 400 × (TIF 4687 KB)

Supplementary material 5 (DOC 41 KB)

Supplementary material 6 (DOC 34 KB)

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Tao, X., Wang, K., Dong, J. et al. Clinical features, surgical management, and prognostic factors of secretory meningiomas: a single-center case series of 149 patients. J Neurooncol 136, 515–522 (2018). https://doi.org/10.1007/s11060-017-2671-x

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