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The influence of age on the histological grading of meningiomas

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Abstract

This study was undertaken to assess the relationship between the age of patients at the time of their surgery and histological grading of meningiomas. A retrospective review was conducted for 1,083 consecutive patients with meningiomas who had surgical removal between January 1991 and December 2006. Histological grading for each tumor was done utilizing the WHO classification for meningiomas. The incidence of WHO grade II or III tumors between the elderly and the non-elderly groups was compared. The mean age at diagnosis for the WHO grade I, II, and III tumors was 55.1 (±14.79), 59.0 (±15.54), and 64.3 years (±13.28) (p value = 0.007), respectively. We found that 11.9 % of meningiomas diagnosed after the age of 60 years was WHO grade II or III, while this value was only 6.9 % for patients 60 years or younger (p = 0.0006). Our study showed that the combined incidence of WHO grade II and III meningiomas increases as age advances. We believe that this constitutes an important piece of information requiring neurosurgeons to carefully and continuously observe the elderly patients harboring meningiomas.

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Acknowledgments

This study was presented at the annual meeting of the American Association of Neurological Surgeons on May 06, 2009 in San Diego, CA and received the 2009 Synthes Skull Base Award.

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Authors and Affiliations

  1. Brain Tumor and Neuro-Oncology Center, Desk R-20, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Jae-Sung Park, Burak Sade, Soichi Oya, Chong Gue Kim & Joung H. Lee

  2. Department of Neurosurgery, Konkuk University School of Medicine, 82, Gugwon-daero, Chungju-si, Chungcheongbuk-do, 380-704, Republic of Korea

    Jae-Sung Park

Authors
  1. Jae-Sung Park
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  2. Burak Sade
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  3. Soichi Oya
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  4. Chong Gue Kim
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  5. Joung H. Lee
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Corresponding author

Correspondence to Joung H. Lee.

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Comments

Nobutaka Kawahara, Yokohama, Japan

With the increasing availability of modern neuroimaging modalities, natural history of small meningioma has recently become a topic in neurosurgery. These studies showed that annual growth rate of incidentally found small meningiomas (asymptomatic) are generally very low, and that they can be followed up by imaging studies 1–3. The proposed risk factors for a higher growth rate among these are quite variable, but several factors seem common such as larger size, T2 hyperintensity, and younger age. These epidemiological findings provide important information for decision making by neurosurgeons.

In this article, the authors asked another question whether age is correlated with the histological grade of meningioma. By analyzing a large number of their surgical series, they found that WHO grade II and III meningiomas are more frequent in elderly patients, which is rather unexpected for most neurosurgeons. As stated in the discussion, malignant progression from benign form may occur in the elderly, similar to malignant transformation of astrocytoma to secondary glioblastoma. The authors are congratulated for providing us a different aspect of meningioma study.

However, this finding should be cautiously interpreted. In a different large series of more than 7,000 cases, higher grade meningiomas were observed in younger age 4. In addition, when considering the data of natural history, higher percentage of meningiomas in the elderly would be observed more frequently, leading to selection bias in the study. More complicated is the definition of grade II, which was revised in the 2007 version. Nonetheless, this issue has an important clinical implication since management and care of elderly patients harboring meningioma would definitely increase in the future.

References

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3. Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT: Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg 113:1,036–1,042, 2010

4. Wang DJ, Xie Q, Gong Y, Mao Y, Wang Y, Cheng HX, et al: Histopathological classification and location of consecutively operated meningiomas at a single institution in China from 2001 to 2010. Chin Med J (Engl) 126:488–493, 2013

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Park, JS., Sade, B., Oya, S. et al. The influence of age on the histological grading of meningiomas. Neurosurg Rev 37, 425–429 (2014). https://doi.org/10.1007/s10143-014-0537-7

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