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Upreti T, Dube S, Pareek V, Sinha N, Shankar J. Meningioma grading via diagnostic imaging: A systematic review and meta-analysis. Neuroradiology 2024; 66:1301-1310. [PMID: 38902484 PMCID: PMC11246317 DOI: 10.1007/s00234-024-03404-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/09/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Meningioma is the most common intracranial tumor, graded on pathology using WHO criteria to predict tumor course and treatment. However, pathological grading via biopsy may not be possible in cases with poor surgical access due to tumor location. Therefore, our systematic review aims to evaluate whether diagnostic imaging features can differentiate high grade (HG) from low grade (LG) meningiomas as an alternative to pathological grading. METHODS Three databases were searched for primary studies that either use routine magnetic resonance imaging (MRI) or computed tomography (CT) to assess pathologically WHO-graded meningiomas. Two investigators independently screened and extracted data from included studies. RESULTS 24 studies met our inclusion criteria with 12 significant (p < 0.05) CT and MRI features identified for differentiating HG from LG meningiomas. Cystic changes in the tumor had the highest specificity (93.4%) and irregular tumor-brain interface had the highest positive predictive value (65.0%). Mass effect had the highest sensitivity (81.0%) and negative predictive value (90.7%) of all imaging features. Imaging feature with the highest accuracy for identifying HG disease was irregular tumor-brain interface (79.7%). Irregular tumor-brain interface and heterogenous tumor enhancement had the highest AUC values of 0.788 and 0.703, respectively. CONCLUSION Our systematic review highlight imaging features that can help differentiate HG from LG meningiomas.
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Affiliation(s)
- Tushar Upreti
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Sheen Dube
- Department of Biochemistry, University of Winnipeg, Winnipeg, Canada
| | - Vibhay Pareek
- Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - Namita Sinha
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Department of Pathology, University of Manitoba, Winnipeg, Canada
| | - Jai Shankar
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
- Department of Radiology, University of Manitoba, Winnipeg, Canada.
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Han T, Liu X, Zhou J. Progression/Recurrence of Meningioma: An Imaging Review Based on Magnetic Resonance Imaging. World Neurosurg 2024; 186:98-107. [PMID: 38499241 DOI: 10.1016/j.wneu.2024.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Meningiomas are the most common primary central nervous system tumors. The preferred treatment is maximum safe resection, and the heterogeneity of meningiomas results in a variable prognosis. Progression/recurrence (P/R) can occur at any grade of meningioma and is a common adverse outcome after surgical treatment and a major cause of postoperative rehospitalization, secondary surgery, and mortality. Early prediction of P/R plays an important role in postoperative management, further adjuvant therapy, and follow-up of patients. Therefore, it is essential to thoroughly analyze the heterogeneity of meningiomas and predict postoperative P/R with the aid of noninvasive preoperative imaging. In recent years, the development of advanced magnetic resonance imaging technology and machine learning has provided new insights into noninvasive preoperative prediction of meningioma P/R, which helps to achieve accurate prediction of meningioma P/R. This narrative review summarizes the current research on conventional magnetic resonance imaging, functional magnetic resonance imaging, and machine learning in predicting meningioma P/R. We further explore the significance of tumor microenvironment in meningioma P/R, linking imaging features with tumor microenvironment to comprehensively reveal tumor heterogeneity and provide new ideas for future research.
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Affiliation(s)
- Tao Han
- Department of Radiology, Lanzhou University Second Hospita, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Xianwang Liu
- Department of Radiology, Lanzhou University Second Hospita, Lanzhou, China; Second Clinical School, Lanzhou University, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospita, Lanzhou, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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3
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Chen WW, Wang Y, Hu YC, Zhao YL. Analysis of the common complications and recurrence-related factors of superior parasagittal sinus meningioma. Front Surg 2023; 9:1023021. [PMID: 36684270 PMCID: PMC9852056 DOI: 10.3389/fsurg.2022.1023021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/20/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives Parasagittal meningioma resection is prone to postoperative complications and tumor recurrence because the tumor invades the superior sagittal sinus. This study aimed to clarify the incidence of perioperative complications and the recurrence of superior sagittal paranasal meningiomas and explored potential predictors in this context. Methods The study retrospectively reviewed the clinical, imaging, and follow-up data of parasagittal meningiomas among patients who underwent microsurgical resection in the authors' institution from January 2008 to December 2017. Univariate and multivariate logistic regression analyses were conducted to explore independent predictors of perioperative complications and tumor recurrence. Results A total of 212 parasagittal meningioma patients were included in this study. The incidence of perioperative complications was 23.6% (50/212), and perioperative death occurred in 6 (2.8%) patients. In univariate and multivariate logistic regression analyses of perioperative complications, peritumoral edema ≥1 cm (odds ratio [OR] 2.163, 95% confidence interval [CI] 1.057-4.428, P = 0.035) and the Sindou invasion Class V-VI(OR0.018, 95% CI 1.248-11.064, P = 0.018) were independent predictors. After an average of 83 (39-154) months of clinical follow up among the living 206 patients, 22 (10.7%) patients showed tumor recurrence. In univariate and multivariate logistic regression analyses of tumor recurrence, the Sindou invasion Class III-IV (OR 5.539, 95%CI 1.469-20.884, P = 0.011) and the Sindou invasion Class V-VI (OR 9.144, 95%CI 2.215-37.757, P = 0.002) were independent predictors. Conclusions Peritumoral edema ≥1 cm and the Sindou invasion Class V-VI were the independent predictors of perioperative complications, and the Sindou invasion Class III-IV and the Sindou invasion Class V-VI were the independent predictors of tumor recurrence. The part of the parasagittal meningioma involving the sinus wall should be actively removed to the largest degree possible to reduce the recurrence rate.
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Affiliation(s)
- Wei-Wei Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang-Chun Hu
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Correspondence: Yuan-Li Zhao
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Takase H, Yamamoto T. Bone Invasive Meningioma: Recent Advances and Therapeutic Perspectives. Front Oncol 2022; 12:895374. [PMID: 35847854 PMCID: PMC9280135 DOI: 10.3389/fonc.2022.895374] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Meningioma is the most common primary neoplasm of the central nervous system (CNS). Generally, these tumors are benign and have a good prognosis. However, treatment can be challenging in cases with aggressive variants and poor prognoses. Among various prognostic factors that have been clinically investigated, bone invasion remains controversial owing to a limited number of assessments. Recent study reported that bone invasion was not associated with WHO grades, progression, or recurrence. Whereas, patients with longer-recurrence tended to have a higher incidence of bone invasion. Furthermore, bone invasion may be a primary preoperative predictor of the extent of surgical resection. Increasing such evidence highlights the potential of translational studies to understand bone invasion as a prognostic factor of meningiomas. Therefore, this mini-review summarizes recent advances in pathophysiology and diagnostic modalities and discusses future research directions and therapeutic strategies for meningiomas with bone invasion.
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Affiliation(s)
- Hajime Takase
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- *Correspondence: Hajime Takase, ; orcid.org/0000-0001-5813-1386
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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de Oliveira Silva CB, Araújo B, Ongaratti BR, dos Santos TM, Rech CGSL, Coutinho LB, Ferreira NP, da Costa Oliveira M, Pereira-Lima JFS. Preoperative hematological inflammatory markers associated with grade and survival in Meningiomas. SURGICAL AND EXPERIMENTAL PATHOLOGY 2022. [DOI: 10.1186/s42047-022-00106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractMeningiomas represent the most frequently diagnosed intracranial tumors. Inflammatory cells present in the tumor can modulate both antitumor and protumor functions, and modify the therapeutic response. Hematological inflammatory parameters have provided prognostic information useful in the treatment and clinical evaluation of several tumors. The aim of this study was to evaluate preoperative hematological markers of patients with meningiomas and to relate them to clinical variables and recurrence-regrowth free survival. Eighty-nine patients without corticosteroid therapy were included. Blood test results and tumor characteristics were collected from medical records. Associations between clinical characteristics and the recurrence-regrowth free survival (RFS) were evaluated using Cox proportional hazard analysis and Kaplan-Meier curves. The receiver operating characteristic (ROC) curves were constructed. Of the 89 cases, 73 (82%) were grade I and 16 (18%) grade II. The mean age was 53 ± 13.9 years, with higher frequency in women. Anemia was observed in 23.6% and neutrophilia in 42% of the patients. In univariate analysis, anemia (p = 0.04), neutrophilia (p = 0.02) and neutrophil/lymphocyt ratio (NLR) (p = 0.02) were associated with an increased risk of recurrence-regrowth and shorter RFS. In multivariate analysis, anemia and NLR > 4.1 represented a higher risk of recurrence-regrowth (p = 0.003). The ROC curve analysis showed that only the lymphocyte/monocyte (L/M) > 2.5 was able to predict the tumor grade. The preoperative presence of anemia, neutrophilia, NLR > 4.1 and L/M > 2.5 were associated with a worse prognosis in meningiomas. The use of preoperative hematological inflammatory parameters as prognostic factors can be promissing for evaluation and follow-up of meningiomas.
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Kumar Anand S, Sardari H, Sadeghsalehi A, Bagheri SR, Eden SV, Lawton MT, Alimohammadi E. Radiopathologic predictors of recurrence in patients with a gross totally resected atypical meningioma. Neurol Res 2021; 44:468-474. [DOI: 10.1080/01616412.2021.2022915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Hamid Sardari
- Student Research Committee, Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Sadeghsalehi
- Department of Pathology, Kermanshah University of Medical Sciences, Taleghani Hospital, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Neurosurgery Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sonia V Eden
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Michael T Lawton
- Neurosurgery, Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Ehsan Alimohammadi
- Neurosurgery Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Gunasekaran T, Teow Kheng Leong K, Tze Hui P. Orbital Cellulitis in a Patient With Sphenoid Wing Meningioma. Cureus 2021; 13:e19323. [PMID: 34909289 PMCID: PMC8653855 DOI: 10.7759/cureus.19323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 11/05/2022] Open
Abstract
We report a case of a 43-year-old woman with an underlying right sphenoid wing meningioma (SWM) who complained of increased right eye swelling, proptosis, redness and severe pain for two weeks. Her symptoms started one week after completing radiotherapy. She seeked treatment after a worsening of symptoms. An urgent computed tomography (CT) scan of the brain was done and showed increasing extension of tumour and hypodense areas within intraorbital region of the tumour with intraorbital fat stranding. She was treated as right eye orbital cellulitis with a differential diagnosis of tumour lysis syndrome. She was started on a combination of intravenous antibiotics and improvements were noticed after two days of treatment. This report presents the diagnostic challenge in managing orbital swelling in a patient with sphenoid wing meningioma with inconclusive radiological findings. Orbital cellulitis is an ocular emergency that requires prompt treatment and can potentially be vision and life-threatening, if not addressed early. In such cases with diagnostic dilemma, the decision to treat should be made as early as possible.
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Affiliation(s)
- Thiruvarasu Gunasekaran
- Department of Ophthalmology, Hospital Seri Manjung, Sitiawan, MYS.,Department of Ophthalmology, Hospital Bintulu, Bintulu, MYS
| | | | - Pua Tze Hui
- Department of Ophthalmology, Hospital Bintulu, Bintulu, MYS
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Chen XY, Chen JY, Huang YX, Xu JH, Sun WW, Chen Y, Ding CY, Wang SB, Wu XY, Kang DZ, You HH, Lin YX. Establishment and Validation of an Integrated Model to Predict Postoperative Recurrence in Patients With Atypical Meningioma. Front Oncol 2021; 11:754937. [PMID: 34692542 PMCID: PMC8529147 DOI: 10.3389/fonc.2021.754937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background This study aims to establish an integrated model based on clinical, laboratory, radiological, and pathological factors to predict the postoperative recurrence of atypical meningioma (AM). Materials and Methods A retrospective study of 183 patients with AM was conducted. Patients were randomly divided into a training cohort (n = 128) and an external validation cohort (n = 55). Univariable and multivariable Cox regression analyses, the least absolute shrinkage and selection operator (LASSO) regression analysis, time-dependent receiver operating characteristic (ROC) curve analysis, and evaluation of clinical usage were used to select variables for the final nomogram model. Results After multivariable Cox analysis, serum fibrinogen >2.95 g/L (hazard ratio (HR), 2.43; 95% confidence interval (CI), 1.05–5.63; p = 0.039), tumor located in skull base (HR, 6.59; 95% CI, 2.46-17.68; p < 0.001), Simpson grades III–IV (HR, 2.73; 95% CI, 1.01–7.34; p = 0.047), tumor diameter >4.91 cm (HR, 7.10; 95% CI, 2.52–19.95; p < 0.001), and mitotic level ≥4/high power field (HR, 2.80; 95% CI, 1.16–6.74; p = 0.021) were independently associated with AM recurrence. Mitotic level was excluded after LASSO analysis, and it did not improve the predictive performance and clinical usage of the model. Therefore, the other four factors were integrated into the nomogram model, which showed good discrimination abilities in training cohort (C-index, 0.822; 95% CI, 0.759–0.885) and validation cohort (C-index, 0.817; 95% CI, 0.716–0.918) and good match between the predicted and observed probability of recurrence-free survival. Conclusion Our study established an integrated model to predict the postoperative recurrence of AM.
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Affiliation(s)
- Xiao-Yong Chen
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jin-Yuan Chen
- Department of Ophthalmology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yin-Xing Huang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jia-Heng Xu
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wei-Wei Sun
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yue- Chen
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chen-Yu Ding
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shuo-Bin Wang
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xi-Yue Wu
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - De-Zhi Kang
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hong-Hai You
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, Neurosurgical Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Sofela AA, McGavin L, Whitfield PC, Hanemann CO. Biomarkers for differentiating grade II meningiomas from grade I: a systematic review. Br J Neurosurg 2021; 35:696-702. [PMID: 34148477 DOI: 10.1080/02688697.2021.1940853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION There are a number of prognostic markers (methylation, CDKN2A/B) described to be useful for the stratification of meningiomas. However, there are currently no clinically validated biomarkers for the preoperative prediction of meningioma grade, which is determined by the histological analysis of tissue obtained from surgery. Accurate preoperative biomarkers would inform the pre-surgical assessment of these tumours, their grade and prognosis and refine the decision-making process for treatment. This review is focused on the more controversial grade II tumours, where debate still surrounds the need for adjuvant therapy, repeat surgery and frequency of follow up. METHODS We evaluated current literature for potential grade II meningioma clinical biomarkers, focusing on radiological, biochemical (blood assays) and immunohistochemical markers for diagnosis and prognosis, and how they can be used to differentiate them from grade I meningiomas using the post-2016 WHO classification. To do this, we conducted a PUBMED, SCOPUS, OVID SP, SciELO, and INFORMA search using the keywords; 'biomarker', 'diagnosis', 'atypical', 'meningioma', 'prognosis', 'grade I', 'grade 1', 'grade II' and 'grade 2'. RESULTS We identified 1779 papers, 20 of which were eligible for systematic review according to the defined inclusion and exclusion criteria. From the review, we identified radiological characteristics (irregular tumour shape, tumour growth rate faster than 3cm3/year, high peri-tumoural blood flow), blood markers (low serum TIMP1/2, high serum HER2, high plasma Fibulin-2) and histological markers (low H3K27me3, low SMARCE1, low AKAP12, high ARIDB4) that may aid in differentiating grade II from grade I meningiomas. CONCLUSION Being able to predict meningioma grade at presentation using the radiological and blood markers described may influence management as the likely grade II tumours will be followed up or treated more aggressively, while the histological markers may prognosticate progression or post-treatment recurrence. This to an extent offers a more personalised treatment approach for patients.
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Affiliation(s)
- Agbolahan A Sofela
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, Plymouth, UK.,South West Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Lucy McGavin
- Department of Radiology, Derriford Hospital, Plymouth, UK
| | - Peter C Whitfield
- South West Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - C Oliver Hanemann
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, Plymouth, UK
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Vega-Moreno DA, Santellán-Hernández JO, Velázquez-Domínguez HE, Martínez-Nava AO, Vicuña-González RM, Mendoza-Trillo PR, Reyes-Rodríguez VA, de la-Torre AI, González-González IE, Ochoa-Cacique D, Sánchez-Mata R, Molina-Martínez RP, García-González U. Histopathological Correlation (World Health Organization Classification) of Meningiomas and Their Anatomical Localization: A Multicenter Epidemiological Study in Mexico. World Neurosurg 2021; 151:e888-e898. [PMID: 33974982 DOI: 10.1016/j.wneu.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the epidemiology of the localization and histological type of meningiomas in the Mexican population and the distribution of the different histological patterns and their relationship to tumor localization and patient demographics. METHODS A retrospective analysis was performed in 5 hospitals in Mexico from 2009 to 2019. For qualitative variables, mean values were compared using Pearson χ2 test for the correlation between location and histological pattern as well as the clinical presentation and the patient's sex. Student t test was performed for age and its correlation with location and histology. RESULTS Analysis of 179 patients revealed significant differences in histopathological pattern, patient sex, and tumor location. No significant differences were found for age or clinical presentation in association with any specific histological pattern. CONCLUSIONS There was a correlation between the histology of the 15 histopathological varieties of meningiomas and the predilection site of appearance as well as certain demographic aspects, such as sex. This study lays the foundation for future studies in Mexico on the differentiation and typing of meningiomas regardless of the histological grade to which they belong, as the exact behavior of these tumors, including grade I tumors, remains unknown to date.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Diego Ochoa-Cacique
- Neurosurgery Department, Hospital Central Sur de Alta Especialidad PEMEX, Mexico City, Mexico
| | - Rafael Sánchez-Mata
- Neurosurgery Department, Hospital Central Sur de Alta Especialidad PEMEX, Mexico City, Mexico
| | | | - Ulises García-González
- Neurosurgery Department, Hospital Central Sur de Alta Especialidad PEMEX, Mexico City, Mexico
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11
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Chun SW, Kim KM, Kim MS, Kang H, Dho YS, Seo Y, Kim JW, Kim YH, Park CK. Adjuvant radiotherapy versus observation following gross total resection for atypical meningioma: a systematic review and meta-analysis. Radiat Oncol 2021; 16:34. [PMID: 33596974 PMCID: PMC7890913 DOI: 10.1186/s13014-021-01759-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background The impact of adjuvant radiotherapy (RT) on atypical meningioma (AM) underwent a gross total resection (GTR) remains unclear, showing conflicting results from various studies. The objective of this study was to perform an updated meta-analysis for observational studies to determine the effect of adjuvant RT after GTR on local recurrence and survival outcomes compared to observation after GTR. Methods PubMed, Embase, and Web of Science were searched to identify comparative studies that reported outcomes of adjuvant RT versus observation for AM patients after GTR. Local recurrence rate, progression-free survival (PFS), overall survival (OS), and toxicities related to RT were considered as outcomes of interest. Differences between two cohorts were estimated by calculating odds ratios (OR) for LR rate and hazard ratios (HR) for survival outcomes with 95% confidence intervals (CIs) for meta-analysis, using R version 4.0.3 software. Included studies were appraised with the Risk of Bias Assessment tool for Non-Randomized Studies. Outcome ratios were combined with the Mantel–Haenszel method and the inverse variance-weighted method, appropriately. Results Data from 30 studies involving 2904 patients (adjuvant RT: n = 737; observation: n = 2167) were eventually included. Significant reduction of local recurrence rate was seen in the adjuvant RT cohort compare to that in the observation cohort (OR 0.50; 95% CI 0.36–0.68; p < 0.0001). Pooled HRs of PFS at 1-year, 3-year, 5-year, and > 5-year revealed that adjuvant RT was superior to observation. There was no significant difference in OS between the two cohorts during any period. Most toxicities were tolerable with grade 1 or 2. There was no documented grade 5 toxicity. Conclusions For AM patients who underwent GTR, evidence suggested that adjuvant RT could potentially decrease local recurrence and improve PFS better than observation.
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Affiliation(s)
- Se-Woong Chun
- Department of Rehabilitation Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Kyung Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Min-Sung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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12
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Fibulin-2: A Novel Biomarker for Differentiating Grade II from Grade I Meningiomas. Int J Mol Sci 2021; 22:ijms22020560. [PMID: 33429944 PMCID: PMC7827565 DOI: 10.3390/ijms22020560] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/21/2022] Open
Abstract
There is an unmet need for the identification of biomarkers to aid in the diagnosis, clinical management, prognosis and follow-up of meningiomas. There is currently no consensus on the optimum management of WHO grade II meningiomas. In this study, we identified the calcium binding extracellular matrix glycoprotein, Fibulin-2, via mass-spectrometry-based proteomics, assessed its expression in grade I and II meningiomas and explored its potential as a grade II biomarker. A total of 87 grade I and 91 grade II different meningioma cells, tissue and plasma samples were used for the various experimental techniques employed to assess Fibulin-2 expression. The tumours were reviewed and classified according to the 2016 edition of the Classification of the Tumours of the central nervous system (CNS). Mass spectrometry proteomic analysis identified Fibulin-2 as a differentially expressed protein between grade I and II meningioma cell cultures. Fibulin-2 levels were further evaluated in meningioma cells using Western blotting and Real-time Quantitative Polymerase Chain Reaction (RT-qPCR); in meningioma tissues via immunohistochemistry and RT-qPCR; and in plasma via Enzyme-Linked Immunosorbent Assay (ELISA). Proteomic analyses (p < 0.05), Western blotting (p < 0.05) and RT-qPCR (p < 0.01) confirmed significantly higher Fibulin-2 (FBLN2) expression levels in grade II meningiomas compared to grade I. Fibulin-2 blood plasma levels were also significantly higher in grade II meningioma patients compared to grade I patients. This study suggests that elevated Fibulin-2 might be a novel grade II meningioma biomarker, when differentiating them from the grade I tumours. The trend of Fibulin-2 expression observed in plasma may serve as a useful non-invasive biomarker.
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Kuranari Y, Tamura R, Tsuda N, Kosugi K, Morimoto Y, Yoshida K, Toda M. Prognostic Significance of Preoperative Neutrophil-to-Lymphocyte Ratio in Patients With Meningiomas. Front Oncol 2020; 10:592470. [PMID: 33330078 PMCID: PMC7732694 DOI: 10.3389/fonc.2020.592470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Meningiomas are the most common benign intracranial tumors. However, even WHO grade I meningiomas occasionally show local tumor recurrence. Prognostic factors for meningiomas have not been fully established. Neutrophil-to-lymphocyte ratio (NLR) has been reported as a prognostic factor for several solid tumors. The prognostic value of NLR in meningiomas has been analyzed in few studies. Materials and Methods This retrospective study included 160 patients who underwent surgery for meningiomas between October 2010 and September 2017. We analyzed the associations between patients’ clinical data (sex, age, primary/recurrent, WHO grade, extent of removal, tumor location, peritumoral brain edema, and preoperative laboratory data) and clinical outcomes, including recurrence and progression-free survival (PFS). Results Forty-four meningiomas recurred within the follow-up period of 3.8 years. WHO grade II, III, subtotal removal, history of recurrence, Ki-67 labeling index ≥3.0, and preoperative NLR value ≥2.6 were significantly associated with shorter PFS (P < 0.001, < 0.001, 0.002, < 0.001, and 0.015, respectively). Furthermore, NLR ≥ 2.6 was also significantly associated with shorter PFS in a subgroup analysis of WHO grade I meningiomas (P = 0.003). In univariate and multivariate analyses, NLR ≥2.6 remained as a significant predictive factor for shorter PFS in patients with meningioma (P = 0.014). Conclusions NLR may be a cost-effective and novel preoperatively usable biomarker in patients with meningiomas.
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Affiliation(s)
- Yuki Kuranari
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Tsuda
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yukina Morimoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Zador Z, Landry AP, Saha A, Cusimano MD. Gene Expression Signatures Identify Biologically Homogenous Subgroups of Grade 2 Meningiomas. Front Oncol 2020; 10:541928. [PMID: 33224871 PMCID: PMC7674612 DOI: 10.3389/fonc.2020.541928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Meningiomas are the most common brain tumor, with prevalence of approximately 3%. Histological grading has a major role in determining treatment choice and predicting outcome. While indolent grade 1 and aggressive grade 3 meningiomas exhibit relatively homogeneous clinical behavior, grade 2 meningiomas are far more heterogeneous, making outcome prediction challenging. We hypothesized two subgroups of grade 2 meningiomas which biologically resemble either World Health Organization (WHO) grade 1 or WHO grade 3. Our aim was to establish gene expression signatures that separate grade 2 meningiomas into two homogeneous subgroups: a more indolent subtype genetically resembling grade 1 and a more aggressive subtype resembling grade 3. Methods We carried out an observational meta-analysis on 212 meningiomas from six distinct studies retrieved from the open-access platform Gene Expression Omnibus. Microarray data was analyzed with systems-level gene co-expression network analysis. Fuzzy C-means clustering was employed to reclassify 34 of the 46 grade 2 meningiomas (74%) into a benign “grade 1-like” (13/46), and malignant “grade 3-like” (21/46) subgroup based on transcriptomic profiles. We verified shared biology between matching subgroups based on meta-gene expression and recurrence rates. These results were validated further using an independent RNA-seq dataset with 160 meningiomas, with similar results. Results Recurrence rates of “grade 1-like” and “grade 3- like” tumors were 0 and 75%, respectively, statistically similar to recurrence rates of grade 1 (17%) and 3 (85%). We also found overlapping biological processes of new subgroups with their adjacent grades 1 and 3. Conclusion These results underpin molecular signatures as complements to histological grading systems. They may help reshape prediction, follow-up planning, treatment decisions and recruitment protocols for future and ongoing clinical trials.
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Affiliation(s)
- Zsolt Zador
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Alexander P Landry
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Ashirbani Saha
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael D Cusimano
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
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DNA repair and cell synthesis proteins: immunohistochemical expression and correlation with recurrence-regrowth in meningiomas. J Mol Histol 2020; 51:411-420. [PMID: 32617895 DOI: 10.1007/s10735-020-09892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
Meningiomas are considered the second most common neoplasm of the central nervous system in adults. Most of them are benign with slow growth, frequent in women and with a high recurrence rate. In tumors, DNA error repair processes lose efficacy, providing mutagenesis and genomic instability. This work evaluated the expression of proteins involved in cell synthesis (cyclin D1) and DNA errors repair (MUTYH, XPF, XPG) in meningiomas, relating them to clinical, tumor and survival variables. The study included 85 patients, with a mean age of 52 ± 13.3 years and most of them women (2:1 ratio). Sixty-seven cases were grade I (79%). Grade II tumors were independent predictors of recurrence-regrowth (HR: 2.8; p = 0.038). The high expression of cyclin D1 was associated with grade II (p = 0.001) and low MUTYH expression with grade I (p = 0.04). Strong expression of XPF and XPG was associated with grade II (p = 0.002; p < 0.001) and with recurrence-regrowth (p = 0.04; p = 0.003). Strong XPF expression was significantly related to large tumors (p = 0.03). An association of cyclin D1, MUTYH and XPF were found. Survival was not associated with the expression of any of the proteins studied. To know the role of DNA repair proteins and cell synthesis is important for understanding the processes of origin and tumor development. Grade II meningiomas and strong expression of XPF and XPG were predictors of recurrence or regrowth and may assist in clinical management, considering the high recurrence of meningiomas and the absence of consensus regarding treatment.
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Kalladka M, Al Obaidi N, Babu LK, Maloth S, Khan J. Medial sphenoid wing parasellar meningioma masquerading as temporomandibular joint disorder. J Am Dent Assoc 2020; 151:210-215. [DOI: 10.1016/j.adaj.2020.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 10/24/2022]
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Impact of postoperative radiotherapy on recurrence of primary intracranial atypical meningiomas. J Neurooncol 2020; 146:347-355. [PMID: 31900826 DOI: 10.1007/s11060-019-03382-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atypical meningiomas (WHO grade II) have high recurrence rate. However, data on the effect of radiotherapy (RT) is still conflicting. The aim of this study was to evaluate the influence of postoperative RT on the recurrence of primary atypical intracranial meningiomas. METHODS The medical records of all patients who underwent surgery (2007-2017 in 4 neurosurgical departments) for a histologically diagnosed primary atypical meningioma were reviewed to assess progression-free survival (PFS) and prognostic factors. RESULTS This analysis included 258 patients with a median age of 60 years (54.7% female). The predominant tumor locations were convexity and falx (60.9%) followed by the skull base (37.2%). Simpson grade I-II resection was achieved in 194 (75.2%) patients, Simpson grade III-IV in 53 patients (20.5%). Tumor progressed in 54 cases (20.9%). Postoperative RT was performed in 46 cases (17.8%). RT was more often applied after incomplete resection (37.7% vs. 13.4% Simpson III-IV vs. I-II). A multivariate analysis showed a significantly shorter PFS associated with Simpson III-IV [HR 1.19, (95% CI) 1.09-1.29, p < 0.001] and age > 65 years [HR 2.89, (95% CI) 1.56-5.33, p = 0.001]. A subgroup analysis with a minimal follow-up of 36 months revealed that Simpson III-IV [HR 3.01, 95% CI 1.31-6.931.03-1.24, p = 0.009] and age > 65 years [HR 2.48, 95% CI 1.20-5.13, p = 0.014] reduced PFS. The impact of postoperative RT on PFS remained statistically insignificant, even in a propensity-score matched survival analysis [n = 46; p = 0.438; OR 0.710 (0.299-1.687)]. CONCLUSIONS In the present study, postoperative RT did not improve PFS. The most important prognostic factors remain the extent of resection and age.
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Magill ST, Young JS, Chae R, Aghi MK, Theodosopoulos PV, McDermott MW. Relationship between tumor location, size, and WHO grade in meningioma. Neurosurg Focus 2019; 44:E4. [PMID: 29606048 DOI: 10.3171/2018.1.focus17752] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Prior studies have investigated preoperative risk factors for meningioma; however, no association has been shown between meningioma tumor size and tumor grade. The objective of this study was to investigate the relationship between tumor size and grade in a large single-center study of patients undergoing meningioma resection. METHODS A retrospective chart review of patients undergoing meningioma resection at the University of California, San Francisco, between 1985 and 2015 was performed. Patients with incomplete information, spinal meningiomas, multiple meningiomas, or WHO grade III meningiomas were excluded. The largest tumor dimension was used as a surrogate for tumor size. Univariate and multivariate logistic regression models were used to investigate the relationship between tumor grade and tumor size. A recursive partitioning analysis was performed to identify groups at higher risk for atypical (WHO grade II) meningioma. RESULTS Of the 1113 patients identified, 905 (81%) had a WHO grade I tumor and in 208 (19%) the tumors were WHO grade II. The median largest tumor dimension was 3.6 cm (range 0.2-13 cm). Tumors were distributed as follows: skull base (n = 573, 51%), convexity/falx/parasagittal (n = 431, 39%), and other (n = 109, 10%). On univariate regression, larger tumor size (p < 0.001), convexity/falx/parasagittal location (p < 0.001), and male sex (p < 0.001) were significant predictors of WHO grade II pathology. After controlling for interactions, multivariate regression found male sex (OR 1.74, 95% CI 1.25-2.43), size 3-6 cm (OR 1.69, 95% CI 1.08-2.66), size > 6 cm (OR 3.01, 95% CI 1.53-5.94), and convexity/falx/parasagittal location (OR 1.83, 95% CI 1.19-2.82) to be significantly associated with WHO grade II. Recursive partitioning analysis identified male patients with tumors > 3 cm as a high-risk group (32%) for WHO grade II meningioma. CONCLUSIONS Larger tumor size is associated with a greater likelihood of a meningioma being WHO grade II, independent of tumor location and male sex, which are known risk factors.
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WHO grade of intracranial meningiomas differs with respect to patient’s age, location, tumor size and peritumoral edema. J Neurooncol 2019; 145:277-286. [DOI: 10.1007/s11060-019-03293-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/16/2019] [Indexed: 12/24/2022]
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Loewenstern J, Shuman W, Rutland JW, Kessler RA, Kohli KM, Umphlett M, Pain M, Bederson J, Fowkes M, Shrivastava RK. Preoperative and Histological Predictors of Recurrence and Survival in Atypical Meningioma After Initial Gross Total Resection. World Neurosurg 2019; 128:e148-e156. [DOI: 10.1016/j.wneu.2019.04.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 12/16/2022]
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Zwirner K, Paulsen F, Schittenhelm J, Gepfner-Tuma I, Tabatabai G, Behling F, Skardelly M, Bender B, Zips D, Eckert F. Integrative assessment of brain and bone invasion in meningioma patients. Radiat Oncol 2019; 14:132. [PMID: 31358024 PMCID: PMC6664715 DOI: 10.1186/s13014-019-1341-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various prognostic factors have been suggested in meningioma patients including WHO grading, brain invasion and bone involvement, for instance. Brain invasion was included as an independent criterion in the recent WHO classification. However, assessability of brain or bone involvement is often limited or varies between histopathologic, operative and imaging reports. Objective of our study was to investigate prognostic values including brain and bone involvement according to different clinical approaches. METHODS A cohort of 111 patients was treated with primary, adjuvant or salvage irradiation between 2008 and 2017 using intensity-modulated radiotherapy. Positron-emission tomography (PET) was available for treatment planning in 81% of patients. Clinical data were extracted from the medical reports. Brain and bone involvement were stratified separately according to histopathologic, operative and imaging reports as well as judged in synopsis. RESULTS WHO grade I tumours, lower estimated proliferation index, primary versus recurrence treatment and localization (i.e. skull base, optic nerve sheath) were beneficial prognostic factors for local control. Judgement of brain and bone invasion partly differed between diagnostic modalities. In synopsis, brain or bone invasion did not show a significant influence on local control rates. CONCLUSIONS Several previously described prognostic factors could be reproduced. However, partly divergent histopathological, surgical and image-based judgements could be found in regard to brain and bone invasion and all methods imply limitations. Therefore, we suggest a particular, complemental synopsis judgement. In synopsis, brain or bone involvement did not coherently impair local control in our irradiated patients. This might be explained by elaborate radiation techniques and PET-based treatment planning.
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Affiliation(s)
- Kerstin Zwirner
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Calwerstr. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Irina Gepfner-Tuma
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Felix Behling
- Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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Spille DC, Sporns PB, Heß K, Stummer W, Brokinkel B. Prediction of High-Grade Histology and Recurrence in Meningiomas Using Routine Preoperative Magnetic Resonance Imaging: A Systematic Review. World Neurosurg 2019; 128:174-181. [PMID: 31082555 DOI: 10.1016/j.wneu.2019.05.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Estimating the risk of recurrence after surgery remains crucial during care of patients with meningioma. Numerous studies identified correlations of characteristics on routine preoperative magnetic resonance imaging (MRI) with postoperative recurrence or high-grade histology but showed partially inconclusive results. METHODS A systematic review of the literature was performed about findings on preoperative MRI and their correlation with high-grade histology and recurrence. Quality of the included studies was analyzed using standardized Quality Assessment of Diagnostic Accuracy Studies criteria. RESULTS Among the 35 studies included, quality of the series according to the Quality Assessment of Diagnostic Accuracy Studies criteria differed widely. Remarkably, MRI variables found to be associated with high-grade histology were commonly not consistently associated with prognosis and vice versa. Correlations of the tumor size, the peritumoral edema size, and contrast-enhancement of the tumor capsule with high-grade histology were controversial. In most studies, non-skull base tumor location, cyst formation, heterogenous contrast-enhancement, an irregular tumor shape, and disruption of the tumor/brain border but not intensity of the lesion on T2-weighted images, calcifications, or bone involvement were associated with grade II/III histology. Although tumor and edema size were usually found to correlate with recurrence, heterogenous contrast enhancement, cyst formation, intensity of the tumor on T2-weighted MRI, and enhancement of the tumor capsule were mostly not related with progression. CONCLUSIONS Several mostly consistent but partially inconsistent variables associated with high-grade histology or prognosis were identified. Although standardized studies are needed to provide further clarification, consideration of these findings can help to improve estimation of prognosis and can therefore improve postoperative care in patients with meningioma.
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Affiliation(s)
| | - Peter B Sporns
- Institute of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Katharina Heß
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
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Zhang G, Zhang Y, Zhang G, Li D, Wu Z, Wang Y, Zhang J. Outcome and prognostic factors for atypical meningiomas after first recurrence. J Clin Neurosci 2019; 63:100-105. [DOI: 10.1016/j.jocn.2019.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/21/2018] [Accepted: 01/18/2019] [Indexed: 02/07/2023]
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Friconnet G, Espíndola Ala VH, Janot K, Brinjikji W, Bogey C, Lemnos L, Salle H, Saleme S, Mounayer C, Rouchaud A. MRI predictive score of pial vascularization of supratentorial intracranial meningioma. Eur Radiol 2019; 29:3516-3522. [DOI: 10.1007/s00330-019-06197-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
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Niu L, Zhou X, Duan C, Zhao J, Sui Q, Liu X, Zhang X. Differentiation Researches on the Meningioma Subtypes by Radiomics from Contrast-Enhanced Magnetic Resonance Imaging: A Preliminary Study. World Neurosurg 2019; 126:e646-e652. [PMID: 30831287 DOI: 10.1016/j.wneu.2019.02.109] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Meningioma subtypes are one of the most common key points to the treatment and prognosis of patients. The purpose of this study was to investigate the differential diagnostic value of radiomics features on meningioma. METHODS A total of 241 patients with meningioma who had undergone tumor resection were randomly selected including 80 with meningothelial meningioma, 80 with fibrous meningioma, and 81 with transitional meningioma. These meningiomas were divided into 4 groups including: meningothelial versus fibrous (group 1), fibrous versus transitional (group 2), meningothelial versus transitional (group 3), and meningothelial versus fibrous versus transitional (group 4). All patients were examined using the same magnetic resonance scanner (GE 3.0 T) and the preoperative contrast-enhanced T1-weighted images were available. Radiomics features from the contrast-enhanced T1-weighted images of 241 patients were evaluated by 2 experienced radiology specialists. RESULTS A total of 385 radiomics features were extracted from the images of each patient. Several preprocessing methods were applied on the radiomics dataset to reduce the redundancy and highlight differences between different meningioma before the Fisher discrimination analysis was adopted and leave one out cross validation methods were used for the model validation. The differentiation accuracies of the Fisher discriminant analysis model for groups 1, 2, 3, and 4 were 99.4%, 98.8%, 100% and 100%, respectively; leave one out cross validation method was achieved for group 1, 2, 3, and 4 with the accuracies of 91.3%, 95.0%, 100%, and 94.2%, respectively. CONCLUSIONS Radiomics features and the combined Fisher discriminant analysis could provide satisfactory performance in the preoperative differential diagnosis of meningioma subtypes and enable the potential ability for clinical application.
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Affiliation(s)
- Lei Niu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao
| | - Xiaoming Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao
| | - Chongfeng Duan
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao
| | - Jiping Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao
| | - Qinglan Sui
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao
| | - Xuejun Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao.
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Li H, Zhang YS, Zhang GB, Zhang GJ, Wang B, Li D, Wu Z, Zhang JT. Treatment Protocol, Long-Term Follow-Up, and Predictors of Mortality in 302 Cases of Atypical Meningioma. World Neurosurg 2019; 122:e1275-e1284. [DOI: 10.1016/j.wneu.2018.11.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 11/29/2022]
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Li X, Miao Y, Han L, Dong J, Guo Y, Shang Y, Xie L, Song Q, Liu A. Meningioma grading using conventional MRI histogram analysis based on 3D tumor measurement. Eur J Radiol 2019; 110:45-53. [DOI: 10.1016/j.ejrad.2018.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/04/2018] [Accepted: 11/18/2018] [Indexed: 10/27/2022]
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Lavrador JP, Acharya S, Giamouriadis A, Vergani F, Ashkan K, Bhangoo R. Letter to the Editor. Intermediate-risk meningioma and NRG Oncology RTOG 0539. J Neurosurg 2018; 129:1651-1653. [PMID: 30265197 DOI: 10.3171/2018.4.jns18811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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29
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Shakir SI, Souhami L, Petrecca K, Mansure JJ, Singh K, Panet-Raymond V, Shenouda G, Al-Odaini AA, Abdulkarim B, Guiot MC. Prognostic factors for progression in atypical meningioma. J Neurosurg 2018; 129:1240-1248. [PMID: 29350599 DOI: 10.3171/2017.6.jns17120] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/19/2017] [Indexed: 11/06/2022]
Abstract
In patients with postoperative residual atypical meningiomas, by using volumetric instead of linear measurements in follow-up imaging studies, the authors detected disease progression earlier. By using this approach, treatment for recurrent disease can be instituted promptly with potentially better tumor control and less toxicity due to smaller volume of residual disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Amal A Al-Odaini
- 5Neuropathology, Cedars Cancer Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Marie-Christine Guiot
- 5Neuropathology, Cedars Cancer Centre, McGill University Health Centre, Montreal, Quebec, Canada
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Budohoski KP, Clerkin J, Millward CP, O'Halloran PJ, Waqar M, Looby S, Young AMH, Guilfoyle MR, Fitzroll D, Devadass A, Allinson K, Farrell M, Javadpour M, Jenkinson MD, Santarius T, Kirollos RW. Predictors of early progression of surgically treated atypical meningiomas. Acta Neurochir (Wien) 2018; 160:1813-1822. [PMID: 29961125 PMCID: PMC6105233 DOI: 10.1007/s00701-018-3593-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/11/2018] [Indexed: 02/06/2023]
Abstract
Background Clinical behaviour of atypical meningiomas is not uniform. While, as a group, they exhibit a high recurrence rate, some pursue a more benign course, whereas others progress early. We aim to investigate the imaging and pathological factors that predict risk of early tumour progression and to determine whether early progression is related to outcome. Methods Adult patients with WHO grade II meningioma treated in three regional referral centres between 2007 and 2014 were included. MRI and pathology characteristics were assessed. Gross total resection (GTR) was defined as Simpson 1–3. Recurrence was classified into early and late (≤ 24 vs. > 24 months). Results Among the 220 cases, 37 (16.8%) patients progressed within 24 months of operation. Independent predictors of early progression were subtotal resection (STR) (p = 0.005), parafalcine/parasagittal location (p = 0.015), peritumoural oedema (p = 0.027) and mitotic index (MI) > 7 (p = 0.007). Adjuvant radiotherapy was negatively associated with early recurrence (p = 0.046). Thirty-two per cent of patients with residual tumour and 26% after GTR received adjuvant radiotherapy. There was a significantly lower proportion of favourable outcomes at last follow-up (mRS 0–1) in patients with early recurrence (p = 0.001). Conclusions Atypical meningiomas are a heterogeneous group of tumours with 16.8% patients having recurrence within 24 months of surgery. Residual tumour, parafalcine/parasagittal location, peritumoural oedema and a MI > 7 were all independently associated with early recurrence. As administration of adjuvant radiotherapy was not protocolised in this cohort, any conclusions about benefits of irradiation of WHO grade II meningiomas should be viewed with caution. Patients with early recurrence had worse neurological outcome. While histological and imaging characteristics provide some prognostic value, further molecular characterisation of atypical meningiomas is warranted to aid clinical decision making.
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Affiliation(s)
- Karol P Budohoski
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK.
| | - James Clerkin
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | | | | | - Mueez Waqar
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Seamus Looby
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Adam M H Young
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
| | - Mathew R Guilfoyle
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
| | - Diana Fitzroll
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
| | - Abel Devadass
- Department of Neuropathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Kieren Allinson
- Department of Neuropathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | | | | | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Thomas Santarius
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
| | - Ramez W Kirollos
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
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Karimi S, Vyas MV, Gonen L, Tabasinejad R, Ostrom QT, Barnholtz-Sloan J, Suppiah S, Zadeh G, Aldape K. Prognostic significance of preoperative neutrophilia on recurrence-free survival in meningioma. Neuro Oncol 2018; 19:1503-1510. [PMID: 28531342 DOI: 10.1093/neuonc/nox089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Meningioma is the most common primary intracranial tumor and recurrence is one of the important challenges in patient management. Prognostic factors for tumor recurrences in these patients especially before surgical resection are not fully characterized. Several studies have indicated an association between changes in hematologic laboratory parameters with patient outcomes in solid malignancies. We aimed to assess the association between hematologic parameters and tumor recurrence in patients with meningioma. Methods Preoperative complete blood count (CBC) data were analyzed in patients with newly diagnosed meningioma (n = 222). Clinical data, including history of corticosteroid therapy, tumor characteristics, and follow-up, were obtained. Recurrence-free survival (RFS) was evaluated using Cox proportional hazards models and log-rank tests. Results Using preoperative CBC data from patients prior to any steroid therapy, 51 (23%) patients had neutrophilia. In univariate analysis, neutrophilia was significantly associated with meningioma recurrence (hazard ratio [HR] 2.73; P < 0.01). Neither leukocytosis nor lymphocytosis was associated with RFS. In multivariate analysis, after adjusting for tumor grade, tumor size, and extent of resection, neutrophilia remained an independent prognostic factor for RFS (HR 2.23, P = 0.01). Forty-six (21%) patients had low hemoglobin levels indicative of anemia, and the presence of anemia showed a trend toward high risk for recurrence (HR 1.83; P = 0.06). Conclusions The presence of neutrophilia was associated with higher rate of tumor recurrence in patients with meningioma. Validation of these results and the biologic role of neutrophilic inflammatory/immune reaction in meningioma requires further investigation.
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Affiliation(s)
- Shirin Karimi
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Manav V Vyas
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Lior Gonen
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Raha Tabasinejad
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Quinn T Ostrom
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jill Barnholtz-Sloan
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Suganth Suppiah
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Gelareh Zadeh
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth Aldape
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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Kohli KM, Loewenstern J, Kessler RA, Pain M, Palmese CA, Bederson J, Shrivastava RK. Antidepressant use in patients with meningioma: is there an association with tumor recurrence? Neurosurg Focus 2018; 44:E14. [DOI: 10.3171/2018.3.focus17797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEWith increasing general use of antidepressants (ADs), multiple studies have noted a small protective effect of ADs for patients with glioma, but their impact on meningioma has not been established. This study aims to evaluate the role of ADs in the context of additional clinical factors in relation to long-term risk of meningioma recurrence.METHODSOne hundred five patients with an intracranial meningioma presenting from 2011–2014 with at least 3 years of follow-up (median 4.2 years) after resection were reviewed. AD use along with demographics, tumor characteristics, and outcomes were recorded. Multivariate logistic regression was used to analyze the association of AD use with tumor recurrence, including other clinical measures significantly associated with recurrence as covariates.RESULTSTwenty-nine patients (27.4%) were taking ADs (27 selective serotonin reuptake inhibitors, 2 norepinephrine-dopamine reuptake inhibitors) prior to tumor recurrence. Their tumors largely affected the frontal (31.0%) or parietal lobe (17.2%) and were located in convexity, parasagittal, or falcine (CPF) areas more frequently than skull base areas relative to the tumors of non-AD users (p = 0.035). AD use was found to be an independent predictor of recurrence, in addition to subtotal resection and WHO grade II/III classification (p values < 0.05). The median time from AD prescription to tumor recurrence was 36.6 months (interquartile range [IQR] = 20.9–62.9 months) and median length of AD use was 41.4 months (IQR = 24.7–62.8 months).CONCLUSIONSAD use was an independent predictor of meningioma recurrence. This association may be due to mood or affective changes caused by tumor location in CPF regions that may be a sign of early recurrence. The finding calls attention to AD use in the management of patients with meningioma, and warrants further exploration of an underlying relationship.
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Affiliation(s)
| | | | | | | | | | | | - Raj K. Shrivastava
- Departments of 1Neurosurgery,
- 4Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
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Lam Shin Cheung V, Kim A, Sahgal A, Das S. Meningioma recurrence rates following treatment: a systematic analysis. J Neurooncol 2017; 136:351-361. [DOI: 10.1007/s11060-017-2659-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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Phonwijit L, Khawprapa C, Sitthinamsuwan B. Progression-Free Survival and Factors Associated with Postoperative Recurrence in 126 Patients with Atypical Intracranial Meningioma. World Neurosurg 2017; 107:698-705. [DOI: 10.1016/j.wneu.2017.08.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
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35
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CyberKnife Stereotactic Radiosurgery for Atypical and Malignant Meningiomas. World Neurosurg 2016; 91:574-581.e1. [DOI: 10.1016/j.wneu.2016.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
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36
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Ongaratti BR, Silva CBO, Trott G, Haag T, Leães CGS, Ferreira NP, Oliveira MC, Pereira-Lima JFS. Expression of merlin, NDRG2, ERBB2, and c-MYC in meningiomas: relationship with tumor grade and recurrence. Braz J Med Biol Res 2016; 49:e5125. [PMID: 27007654 PMCID: PMC4819410 DOI: 10.1590/1414-431x20155125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/17/2015] [Indexed: 11/22/2022] Open
Abstract
Meningiomas are common, usually benign tumors of the central nervous system that have a high rate of post-surgical recurrence or regrowth. We determined expression of the proteins merlin, NDRG2, ERBB2, and c-MYC in meningiomas using immunohistochemistry and assessed relationships between protein expression and gender, age, tumor grade, and recurrence or regrowth. The study sample comprised 60 patients, (44 women and 16 men) with a mean age of 53.2 ± 12.7 years. Tumors were classified as grade I (n=48) or grades II and III (n=12). Expression of merlin, NDRG2, ERBB2, and c-MYC was not significantly different statistically with relation to gender, age, or meningioma recurrence or regrowth. Merlin was expressed in 100% of the cases. No statistically significant difference between tumor grade and recurrence or regrowth was identified. Statistically significant differences were identified between the mean age of patients with grade I (54.83 ± 11.60) and grades II and III (46.58 ± 15.08) meningiomas (P=0.043), between strong c-MYC expression and grades II and III (P<0.001), and between partial surgical resection and tumor recurrence or regrowth (P<0.001). These findings reveal the lower mean age among grades II and III meningioma patients than grade I patients, the influence of the protein merlin on tumorigenesis, the association of c-MYC with aggressive meningiomas, and that partial surgical resection is associated with tumor recurrence or regrowth.
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Affiliation(s)
- B R Ongaratti
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - C B O Silva
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - G Trott
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - T Haag
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - C G S Leães
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - N P Ferreira
- Centro de Neuroendocrinologia, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | - M C Oliveira
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
| | - J F S Pereira-Lima
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
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Li P, Yang Z, Wang Z, Zhou Q, Li S, Wang X, Wang B, Zhao F, Liu P. Clinical features of clear cell meningioma: a retrospective study of 36 cases among 10,529 patients in a single institution. Acta Neurochir (Wien) 2016; 158:67-76. [PMID: 26573513 DOI: 10.1007/s00701-015-2635-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clear cell meningioma (CCM) is a rare subtype of meningioma. We present the largest series of 36 CCMs and evaluate several prognostic factors of patient's clinical outcome. METHODS Thirty-six patients with pathologically confirmed CCM among a total of 10,529 meningioma patients were retrospectively reviewed. RESULTS CCM constituted 0.3 % of the intracranial meningiomas and 1.4 % of the intraspinal meningiomas. The male-to-female ratio (36 vs 64 %) for CCMs was similar to that for total meningiomas (28 vs 72 %) patients (chi-squared test, p = 0.3). The mean age at diagnosis of CCM patients (29.3 ± 18.4 years) was significantly younger than that of total meningiomas (49.8 ± 11.9 years) patients (t-test, p = 0). During the follow-up, 15 patients (42 %) suffered from tumor recurrence. The recurrence time ranged from 10 months to 12 years, with a median time of 29 months. Kaplan-Meier survival analysis showed that patients after total resection (Simpson grades I and II) had significantly longer progression-free survival (PFS) time than those after subtotal resection (Simpson grades III and IV) (log-rank test, p = 0.006). However, age (≤20 years or >20 years, p = 0.9), gender (p = 0.3), postoperative radiotherapy (p = 0.4), progesterone receptor staining (positivity or negativity, p = 0.2), and Ki-67 index (≤5 % or >5 %, p = 0.4) did not have significant effects on patients' PFS time. CONCLUSIONS The proportion of CCM in spinal meningiomas is likely to be much larger than that in intracranial meningiomas. CCMs should be resected totally when possible to decrease the risk of recurrence or prolong patient's PFS time.
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Affiliation(s)
- Peng Li
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China
| | - Zhijun Yang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China
| | - Zhenmin Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China
| | - Qiangyi Zhou
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China
| | - Shiwei Li
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China
| | - Xingchao Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China
| | - Fu Zhao
- Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Pinan Liu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China.
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Cohen-Inbar O, Lee CC, Schlesinger D, Xu Z, Sheehan JP. Long-Term Results of Stereotactic Radiosurgery for Skull Base Meningiomas. Neurosurgery 2015; 79:58-68. [DOI: 10.1227/neu.0000000000001045] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
BACKGROUND:
Gamma knife radiosurgery (GKRS) is well established in the management of inaccessible, recurrent, or residual benign skull base meningiomas. Most series report clinical outcome parameters and complications in the short intermediate period after radiosurgery. Reports of long-term tumor control and neurological status are still lacking.
OBJECTIVE:
To report the presentation, treatment, and long-term outcome of skull base meningiomas after GKRS.
METHODS:
From a prospectively collected institutional review board-approved database, we selected patients with a World Health Organization grade I skull base meningioma treated with a single-session GKRS and a minimum of 60 months follow-up. One hundred thirty-five patients, 54.1% males (n = 73), form the cohort. Median age was 54 years (19–80). Median tumor volume was 4.7 cm3 (0.5–23). Median margin dose was 15 Gy (7.5–36). Median follow-up was 102.5 months (60.1–235.4). Patient and tumor characteristics were assessed to determine the predictors of neurological function and tumor progression.
RESULTS:
At last follow-up, tumor volume control was achieved in 88.1% (n = 119). Post-GKRS clinical improvement or stability was reported in 61.5%. The 5-, 10-, and 15-year actuarial progression-free survival rates were 100%, 95.4%, and 68.8%, respectively. Favorable outcome (both tumor control and clinical preservation/improvement) was attained in 60.8% (n = 79). Pre-GKRS performance status (Karnofsky Performance Scale) was shown to influence tumor progression (P = .001) and post-GKRS clinical improvement/preservation (P = .003).
CONCLUSION:
GKRS offers a highly durable rate of tumor control for World Health Organization grade I skull base meningiomas, with an acceptably low incidence of neurological deficits. The Karnofsky Performance Scale at the time of radiosurgery serves as a reliable long-term predictor of overall outcome.
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Affiliation(s)
- Or Cohen-Inbar
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Cheng-chia Lee
- Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - David Schlesinger
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P. Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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