TY - JOUR
T1 - Volumetric extent of resection and survival for recurrent atypical meningioma
AU - Przybylowski, Colin J.
AU - Suki, Dima
AU - Raza, Shaan Mohammed
AU - DeMonte, Franco
N1 - Publisher Copyright:
©AANS 2023, except where prohibited by US copyright law.
PY - 2023/9
Y1 - 2023/9
N2 - OBJECTIVE In recurrent atypical meningioma, the survival impact of volumetric extent of resection (vEOR) and residual tumor volume (RTV) has not been previously studied. METHODS The authors performed a retrospective vEOR analysis of patients with recurrent World Health Organization grade II meningiomas treated with reresection from 2000 to 2019. The Kaplan-Meier method and multivariate Cox regression analysis were used to study progression-free survival (PFS) and overall survival (OS). RESULTS Fifty-nine patients with a median follow-up duration of 95 (95% CI 42–148) months were included. The median (range) vEOR was 100% (32%–100%) and the mean ± SD was 90.7% ± 15.3%. Among patients who underwent gross-total resection (GTR) (n = 32 [54%]), Simpson grade I and II resections were achieved in 23 (72%) and 9 (28%) patients, respectively. Among patients who underwent subtotal resection (n = 27 [46%]), the median (range) RTV was 4.3 (0.3–40) cm3. The 1-, 2-, and 5-year actuarial PFS rates for the cohort were 76%, 56%, and 34%, respectively. The 1-, 2-, and 5-year actuarial OS rates for the cohort were 98%, 78%, and 60%, respectively. Variables reflecting EOR significantly impacted both PFS and OS in multivariate analysis: GTR (p < 0.01) was significantly associated with longer PFS, and lower Simpson grade (p = 0.04) was significantly associated with longer OS. Additional factors including RTV, Ki-67 index, and pretreatment and posttreatment history also impacted survival outcomes (p < 0.05). CONCLUSIONS EOR and Simpson grade were independently associated with survival outcomes in patients with recurrent atypical meningioma. These findings support the practice of thorough reresection for maximal cytoreduction in appropriate surgical candidates.
AB - OBJECTIVE In recurrent atypical meningioma, the survival impact of volumetric extent of resection (vEOR) and residual tumor volume (RTV) has not been previously studied. METHODS The authors performed a retrospective vEOR analysis of patients with recurrent World Health Organization grade II meningiomas treated with reresection from 2000 to 2019. The Kaplan-Meier method and multivariate Cox regression analysis were used to study progression-free survival (PFS) and overall survival (OS). RESULTS Fifty-nine patients with a median follow-up duration of 95 (95% CI 42–148) months were included. The median (range) vEOR was 100% (32%–100%) and the mean ± SD was 90.7% ± 15.3%. Among patients who underwent gross-total resection (GTR) (n = 32 [54%]), Simpson grade I and II resections were achieved in 23 (72%) and 9 (28%) patients, respectively. Among patients who underwent subtotal resection (n = 27 [46%]), the median (range) RTV was 4.3 (0.3–40) cm3. The 1-, 2-, and 5-year actuarial PFS rates for the cohort were 76%, 56%, and 34%, respectively. The 1-, 2-, and 5-year actuarial OS rates for the cohort were 98%, 78%, and 60%, respectively. Variables reflecting EOR significantly impacted both PFS and OS in multivariate analysis: GTR (p < 0.01) was significantly associated with longer PFS, and lower Simpson grade (p = 0.04) was significantly associated with longer OS. Additional factors including RTV, Ki-67 index, and pretreatment and posttreatment history also impacted survival outcomes (p < 0.05). CONCLUSIONS EOR and Simpson grade were independently associated with survival outcomes in patients with recurrent atypical meningioma. These findings support the practice of thorough reresection for maximal cytoreduction in appropriate surgical candidates.
KW - atypical
KW - extent of resection
KW - meningioma
KW - prognosis
KW - recurrence
KW - Simpson grading scale
KW - tumor
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U2 - 10.3171/2022.12.JNS221815
DO - 10.3171/2022.12.JNS221815
M3 - Article
C2 - 36708533
AN - SCOPUS:85169624910
SN - 0022-3085
VL - 139
SP - 769
EP - 779
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 3
ER -