Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review

BACKGROUND

Meningiomas are the most common primary neoplasms of the central nervous system in adults, arising from the arachnoid cap cells. Thus, grade 2 meningiomas are situated on the border between benignity and malignancy. Among the many prognostic factors that have been investigated in these tumors, bone invasion is one of them.

OBJECTIVE

The aim of our study was to identify whether bone invasion influences tumor recurrence and progression-free survival (PFS) in patients with atypical meningiomas (AMs).

PATIENTS, MATERIALS AND METHODS

Out of 81 patients with AMs followed over a period of five years, we identified nine patients with bone invasion. We analyzed their demographic, clinical, imaging, and pathological characteristics, such as age, gender, radiological aspects, morphological features, extent of resection, recurrence rate, and PFS over a follow-up period of 60 months. Bone invasion was determined based on preoperative, surgical, and pathological reports.

RESULTS

Out of the nine patients with bone invasion, four had convexity meningiomas, four had parasagittal meningiomas and one had a falcine meningioma. Regarding tumor recurrence∕progression, most patients (n=6) recurred within the first 24 months after surgery. Our study showed that the early recurrence/progression of tumor (at 12 months) correlated with extensive presence of malignancy criteria, especially with the presence of 15-18 mitoses∕10 high-power fields, as well as with large foci of spontaneous necrosis, but also with tumor bone infiltration, extensive bone lamellae destruction, and tumor infiltration of adjacent muscle with its atrophy due to tumor compression. Patients with bone invasion had a PFS of 29.3 months, compared to patients without invasion who had a higher PFS (49.3 months). Significant statistical associations were observed between bone invasion and tumor recurrence (p=0.002) and PFS (p=0.004).

CONCLUSIONS

Our study emphasizes the importance of a thorough histopathological examination of the surgical specimen, which can provide significant data for the assessment of the progression of an AM [World Health Organization (WHO) grade 2] with bone invasion. AM infiltration in adjacent bone and muscle increases the rate of tumor recurrence and decreases PFS over a follow-up period of 60 months.

Predictor factors for recurrence in atypical meningiomas

BACKGROUND AND OBJECTIVES

Atypical meningiomas (AMs), World Health Organization (WHO) grade 2, are a group of tumors with uneven and unpredictable clinical behavior. Our aim was to analyze possible tumor recurrence predictors, and to identify factors that improve progression-free survival (PFS).

PATIENTS, MATERIALS AND METHODS

Our retrospective study included 81 patients followed up in the Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania, between 1 January 2010 and 31 December 2020. The histopathological specimens were reviewed according to the WHO 2021 criteria. Analyses included clinical, imaging, pathological and surgical factors.

RESULTS

The tumor recurred in 53.1% of the 81 cases within 60 months of surgery. Tumor location (p<0.000), tumor volume (p<0.010), extent of surgical resection (p<0.000) and dural sinus invasion (p<0.001) were predictive factors of recurrence. Gross total resection (Simpson grade I and II) was achieved in 59.2% of patients. Patients with the tumors located in the brain convexity and volume <26.4 cm³ had better survival rates up to recurrence. PFS showed a significant relationship between Simpson grade I-III and biopsy (p<0.000) and was statistically influenced by tumor volume and location, and dural sinus invasion.

CONCLUSIONS

AMs are a heterogeneous group of tumors, and we identified posterior fossa location, volume ≥26.4 cm³, Simpson grade III and IV resection and dural sinus invasion as predictive factors for relapse and a shorter PFS. Whereas certain characteristics provide some prognostic value, future molecular characterizations of AMs are necessary, which will support the clinical decision-making process.

MULTIFACTOR REGRESSION MODEL FOR PREDICTION OF CHRONIC RHINOSINUSITIS RECURRENCE

OBJECTIVE

The aim: To propose an approach to forecasting the risk of chronic rhinosinusitis recurrence based on multivariate regression analysis for effective diagnosis and carrying out treatment and preventive measures.

PATIENTS AND METHODS

Materials and methods: 104 patients aged 18 to 80, including 58 women and 46 men, diagnosed with chronic rhinosinusitis were examined.

RESULTS

Results: To build a multifactorial regression model for predicting the recurrence of chronic rhinosinusitis, probable factors of the occurrence of the disease were selected. 14 possible factors were analyzed using multivariate regression analysis. 13 risk factors were selected for predicting recurrence of chronic rhinosinusitis with a significance level of less than 0.05. Histograms of the residual deviations of predicting the recurrence of chronic rhinosinusitis were obtained, which are distributed symmetrically, and a normal-probability straight line is presented, on which there are no systematic deviations. The given results confirm the statistical hypothesis that the residual deviations correspond to the normal distribution law. Residual deviations relative to the predicted values are scattered chaotically, which indicates the absence of dependence on the predicted values of the risk of recurrence of chronic rhinosinusitis. The value of the coefficient of determination was calculated, which is 0.988, which gives grounds to claim that 98.8% of the factors are taken into account in the model for predicting the recurrence of chronic rhinosinusitis and its high reliability and acceptability in general.

CONCLUSION

Conclusions: The proposed model makes it possible to predict in advance potential complications and the possibility of recurrence of the studied disease.

Postoperative recurrence of primary lung cancer: anatomo-clinical and therapeutic study

BACKGROUND

Lung cancer is the leading cause of cancer mortality worldwide. Even after radical resection, the rate of recurrence of non-small cell lung cancer remains high.

AIM

To identify the profile of patients operated for lung cancer and to study the prognostic factors of tumor recurrence.

METHODS

We performed a retrospective study including 67 cases of lung cancer with curative surgery, hospitalized between 2010 and 2016.

RESULTS

The mean age was 61 years. The sex ratio was 21. The average time to diagnosis was 22 days. The average time to start treatment was 10 days. The most common histological type was adenocarcinoma (63%). Lobectomy was performed in 63% of the patients. Tumor recurrence was noted in 40% of the patients. The average time between recurrence and the surgical treatment was 12 months. The most common location of recurrence was the lung (70%). Recurrence was more common among adenocarcinoma and smokers older than 60 years. The majority of locally advanced and metastatic cancers have recurred. The average survival was 56 ± 4months. Better survival rates were observed in young patients, with less than 25 pack-years of early-stage, no lymph node involvement, and patients who received adjuvant chemotherapy. The probability of survival was 5 years for all tumor stages.

CONCLUSION

The prognostic factors for recurrence after radical resection for lung cancer were: the age of patients, smoking history, histological type, tumor stage, and surgical procedure.

Full-endoscopic transforaminal procedure to treat the single-level adjacent segment disease after posterior lumbar spine fusion: 1-2 years follow-up

Adjacent segment disease (ASD) is one of the potential risks after lumbar spine surgery with instrumentation. Revision surgery needs to be performed on patients suffered from ASD. The traditional open surgery takes severe injury to the body. We investigated the clinical outcome of using full-endoscopic transforaminal procedure to treat the single-level adjacent segment diseases after posterior lumbar fusion. 33 patients (average 71 years, ranged 65-84 years old) underwent full-endoscopic transforaminal procedure were involved. The Oswestry Disability Index (ODI), Modified Japanese Orthopedic Association (mJOA) score and visual analogue scale (VAS) score were used to evaluate the clinical effect. The complication, hospital stay, hospitalization costs and blood loss were investigated according to the patient's records. The mean VAS score was 1.8 and mJOA score was 5.4 postoperatively. Improvement rate was 78%. The mean ODI was 14.6 postoperatively. The mean length of hospital stay, hospitalization costs and blood loss was 2.5 days, $3500 and 15 mL, respectively. No complication or recurrence was observed in any of the patients at the final follow-up. Full-endoscopic transforaminal procedure is a safe and effective technique. It is economical, acceptable and mini-invasive. Of course, it also can shorten the length of hospital stay and decrease bleeding. For revision surgery to treat ASD, this technique can achieve good clinical effects.