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Resected WHO grade I meningioma and predictors of local control

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Abstract

Introduction

Despite optimal surgical resection, meningiomas may recur, with increasing grade and the degree of resection being predictive of risk. We hypothesize that an increasing Ki67 correlates with a higher risk of recurrence of resected WHO grade I meningiomas.

Methods

The study population consisted of patients with resected WHO grade 1 meningiomas in locations outside of the base of skull. Digitally scanned slides stained for Ki67 were analyzed using automatic image analysis software in a standardized fashion.

Results

Recurrence was observed in 53 (17.7%) of cases with a median follow up time of 25.8 months. Ki67 ranged from 0 to 30%. Median Ki67 was 5.1% for patients with recurrence and 3.5% for patients without recurrence. In unadjusted analyses, high Ki-67 (≥ 5 vs. < 5) vs. ≥ 5) was associated with over a twofold increased risk of recurrence (13.1% vs. 27% respectively; HR 2.1731; 95% CI [1.2534, 3.764]; p = 0.006). After Adjusting for patient or tumor characteristics, elevated Ki-67 remained significantly correlated with recurrence. Grade 4 Simpson resection was noted in 71 (23.7%) of patients and it was associated with a significantly increased risk of recurrence (HR 2.56; 95% CI [1.41, 4.6364]; p = 0.002).

Conclusions

WHO grade 1 meningiomas exhibit a significant rate of recurrence following resection. While Ki-67 is not part of the WHO grading criteria of meningiomas, a value greater than 5% is an independent predictor for increased risk of local recurrence following surgical resection.

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Author notes

    Authors and Affiliations

    1. Department of Radiation Oncology, Medstar Franklin Square Hospital, Baltimore, MD, USA

      Kamila Nowak-Choi

    2. Department of Radiation Oncology and Department of Neurosurgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA

      Joshua D. Palmer

    3. Department of Neurosurgery, Sidney Kimmel Medical College, Philadelphia, PA, USA

      James Casey, Ameet Chitale, Kevin Judy, David W. Andrews & Christopher Farrell

    4. Sidney Kimmel Medical College, Philadelphia, PA, USA

      Ingrid Kalchman & Elizabeth Buss

    5. Department of Radiation Oncology, Sidney Kimmel Medical College, Philadelphia, PA, USA

      Wenyin Shi & Maria Werner-Wasik

    6. Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, PA, USA

      Scott W. Keith & Sarah E Hegarty

    7. Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Philadelphia, PA, USA

      Mark Curtis & Charalambos Solomides

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    1. Kamila Nowak-Choi
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    2. Joshua D. Palmer
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    Corresponding author

    Correspondence to Joshua D. Palmer.

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    Institutional IRB approval was obtained for the retrospective review of patient charts.

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    Kamila Nowak Choi and Joshua D. Palmer contributed equally to the published work.

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    Nowak-Choi, K., Palmer, J.D., Casey, J. et al. Resected WHO grade I meningioma and predictors of local control. J Neurooncol 152, 145–151 (2021). https://doi.org/10.1007/s11060-020-03688-1

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    • DOI: https://doi.org/10.1007/s11060-020-03688-1

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