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Extent of resection and survival outcomes in World Health Organization grade II meningiomas

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Abstract

Purpose

WHO grade II meningiomas behave aggressively, with recurrence rates as high as 60%. Although complete resection in low-grade meningiomas is associated with a relatively low recurrence rate, the impact of complete resection for WHO grade II meningiomas is less clear. We studied the association of extent of resection with overall and progression-free survivals in patients with WHO grade II meningiomas.

Methods

A retrospective database review was performed to identify all patients who underwent surgical resection for intracranial WHO grade II meningiomas at our institution between 1995 and 2019. Kaplan–Meier analysis was used to compare overall and progression-free survivals between patients who underwent gross total resection (GTR) and those who underwent subtotal resection (STR). Multivariable Cox proportional-hazards analysis was used to identify independent predictors of tumor recurrence and mortality.

Results

Of 214 patients who underwent surgical resection for WHO grade II meningiomas (median follow-up 53.4 months), 158 had GTR and 56 had STR. In Kaplan–Meier analysis, patients who underwent GTR had significantly longer progression-free (p = 0.002) and overall (p = 0.006) survivals than those who underwent STR. In multivariable Cox proportional-hazards analysis, GTR independently predicted prolonged progression-free (HR 0.57, p = 0.038) and overall (HR 0.44, p = 0.017) survivals when controlling for age, tumor location, and adjuvant radiation.

Conclusions

Extent of resection independently predicts progression-free and overall survivals in patients with WHO grade II meningiomas. In an era of increasing support for adjuvant treatment modalities in the management of meningiomas, our data support maximal safe resection as the primary goal in treatment of these patients.

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Data availability

De-identified raw data available upon request.

Code availability

Available upon request.

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., CA-51, Cleveland, OH, 44195, USA

    Pranay Soni, Mark A. Davison, Lilyana Angelov, Gene H. Barnett, Alireza M. Mohammadi, Varun R. Kshettry & Pablo F. Recinos

  2. Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Pranay Soni, Lilyana Angelov, Gene H. Barnett, Alireza M. Mohammadi, Varun R. Kshettry & Pablo F. Recinos

  3. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Jianning Shao, Arbaz Momin, Diana Lopez, Lilyana Angelov, Gene H. Barnett, Alireza M. Mohammadi, Varun R. Kshettry & Pablo F. Recinos

  4. Department of Neurological Surgery, Hollywood Presbyterian Medical Center, Los Angeles, CA, USA

    Joung H. Lee

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  1. Pranay Soni
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  2. Mark A. Davison
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Correspondence to Pablo F. Recinos.

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Soni, P., Davison, M.A., Shao, J. et al. Extent of resection and survival outcomes in World Health Organization grade II meningiomas. J Neurooncol 151, 173–179 (2021). https://doi.org/10.1007/s11060-020-03632-3

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  • DOI: https://doi.org/10.1007/s11060-020-03632-3

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