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J Neurooncol. 2019 Dec;145(3):469-477. doi: 10.1007/s11060-019-03312-x. Epub 2019 Nov 11.

Microscopic brain invasion in meningiomas previously classified as WHO grade I is not associated with patient outcome.

Author information

1
Department of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany. annamaria.biczok@med.uni-muenchen.de.
2
German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany. annamaria.biczok@med.uni-muenchen.de.
3
German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany.
4
Department of Neurosurgery, University Hospital, Heidelberg, Germany.
5
Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany.
6
Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.
7
Department of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.

Abstract

PURPOSE:

For meningiomas, the 2016 revision of the WHO classification introduced brain invasion per se as a sufficient condition to classify as grade II. We analyzed whether meningiomas previously graded as WHO grade I differ in prognosis depending on the presence of microscopic brain invasion.

METHODS:

A consecutive series of patients with intracranial meningioma WHO grade I (± brain invasion) at two neurosurgical departments was analyzed retrospectively. Cox regression models on progression-free survival (PFS) and Kaplan-Meier survival estimates were performed.

RESULTS:

875 adult patients were included. Histological diagnosis of brain invasion was confirmed in 28 patients. Median follow-up was 73 months. In univariate and multivariate models, gross total resection gained favorable prognostic influence for PFS (p < 0.001, HR: 0.237, CI 0.170-0.382). 170 patients with the brain/meningioma interface present in histopathological specimen were separately analyzed as a subgroup. Importantly, presence of brain invasion did not reach significance for PFS, even in the subgroup with available specimen of brain/meningioma interface (p = 0.787, HR: 0.852, CI 0.268-2.710 and p = 0.811, HR: 0.848, CI 0.222-3.246, respectively). Patients with and without brain invasion did not differ in terms of age, tumor location and extent of resection, but were more likely to receive radiotherapy (p = 0.03) of tumor remnants. However, subgroup analysis of non-irradiated tumors revealed no prognostic influence of brain invasion (p = 0.749, HR: 0.772, CI 0.158-3.767).

CONCLUSIONS:

In this bi-institutional series, brain invasion was frequent among meningiomas WHO grade I when brain/meningioma interface was available for histology (16.5%). However, brain invasion did not impact early recurrence.

KEYWORDS:

Meningioma; Microscopic brain invasion; Prognostic factor; WHO grade I

PMID:
31713016
DOI:
10.1007/s11060-019-03312-x

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