J Korean Neurosurg Soc.  2012 Jul;52(1):14-20. 10.3340/jkns.2012.52.1.14.

Intracranial Meningiomas, WHO Grade Il : Prognostic Implications of Clinicopathologic Features

• Moon HS
• Jung S
• Jang WY
• Jung TY
• Moon KS
• Kim IY

• KMID: 2190517
• DOI: http://doi.org/10.3340/jkns.2012.52.1.14

Abstract

OBJECTIVE
Intracranial meningiomas are primarily benign tumors with a good prognosis. Although WHO grade II meningiomas are rare (2-10%), WHO grade II meningiomas have higher recurrence and mortality rates than benign. We evaluated the patient recurrence rate and investigated the prognostic factors of WHO grade II meningiomas.
METHODS
Between 1993 and 2005, 55 patients were diagnosed with WHO grade II meningiomas in our hospital. WHO grade II meningiomas (n=55) were compared with other WHO grades meningiomas (I, n=373; and III, n=20). The patients had a median age of 48.4 years (range, 14-17 years), a male-to-female ratio of 26 : 29, and a mean follow-up time of 45 months (range, 3-175 months).
RESULTS
In WHO grade II meningiomas, only the extent of resection was a significant prognostic factor. Post-operative radiotherapy had no significant influence on tumor recurrence (p=0.053). The relative risk of recurrence was significantly higher in WHO grade II meningiomas with incomplete resection (10/27, RR=37%) than in WHO grade II meningiomas with complete resection (4/28, RR=14%) regardless of post-operative radiotherapy. In the incomplete resection group, Simpson grade III or IV had a significantly high risk of recurrence regardless of post-operative RT (n=3, RR=100%) However, if the degree of resection was Simpson grade II, the recurrence rate was similar to the complete resection group even though post-operative RT was not performed.
CONCLUSION
Complete resection was the most powerful independent predictive factor of the recurrence rate in WHO grade II meningiomas. Post-operative adjuvant RT was not a significant factor in this study.

Keyword

Meningioma; Recurrence rate; Post-operative radiotherapy; WHO grade II

MeSH Terms

Follow-Up Studies
Humans
Meningioma
Prognosis
Recurrence

Figure

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  Fig. 1 The recurrence rates are similar between the benign meningioma and WHO grade II meningioma complete resection treatment groups. However, the RR is significantly higher for patients with WHO grade II meningiomas with incomplete resection than patients undergoing complete resection. WHO : World Health Organization, RR : relative risk.

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  Fig. 2 Kaplan-Meier recurrence-free survival analysis in patients with meningiomas. A : Recurrences between the pathologic types. The survival curves are significantly better for patients with WHO grade I compared with WHO grade II or III (p=0.001). B : The risk of recurrence is significantly higher with the incomplete resection group than the complete resection group in WHO grade II meningiomas (p=0.05). C : The recurrence rate between the two groups of 'WHO grade II patients who had complete resection' and 'WHO grade I overall (complete or incomplete resection)' are similar. D : Degree of peritumoral edema is also a significant prognostic factor in overall meningiomas (p=0.03). WHO : World Health Organization.

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