Recurrence of atypical and anaplastic intracranial Meningiomas: A meta-analysis of risk factors

Impact of 2021 World Health Organization Grading, Peritumoral Edema, and Radiotherapy on the Recurrence of a Grossly Resected Intracranial Meningiomas: A Ten-Year Follow-Up Study

Background

The significance of histological grading and peritumoral edema (PTE) in predicting intracranial meningioma recurrence among Saudis is often neglected. This study aimed to evaluate the impact of these factors over a 10-year follow-up period.

Methods

A retrospective cohort of 124 patients with intracranial meningioma was analyzed over the period from 2011 to 2021. All patients underwent gross total resection (GTR) of the tumor. Post-surgical radiotherapy (RT) was offered to patients with grade II-III meningiomas. The impact of histological grading, PTE, and RT on the recurrence-free interval (RFI) was investigated.

Results

The mean age of the patients was 49 years (range: 18 - 84), with 87 females (70.2%) and 37 males (29.8%). Most tumors (88.7%, n = 110) were supratentorial, while 11.3% (n = 14) were infratentorial. The World Health Organization (WHO) grading classified 101 tumors (81.5%) as grade I, 17 (13.7%) as grade II, and six (4.8%) patients as grade III. Grading was significantly associated with RFI (P = 0.013), with grade I meningiomas having the slowest recurrence. The overall recurrence rate was 16.9%, with 38.1% (n = 8) of grade I and 61.9% (n = 13) of grade II-III meningiomas recurring within 5 years post-GTR and RT. There was no significant difference in RFI between RT-exposed and non-exposed patients (P = 0.15). PTE was present in 76 cases (61.3%) and absent in 48 (38.7%), significantly affecting RFI (P = 0.014), with shorter RFI in PTE cases. Overall, 95.2% (n = 118) of patients survived, while 4.8% (n = 6) died; five had grade II-III, and one had grade I meningioma.

Conclusions

Totally, resected intracranial meningiomas with grade II-III features and PTE were associated with earlier tumor recurrence and poorer patient survival. Post-surgical RT had an insignificant effect on the RFI.