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Published on: January 14, 2014
Relationship between malignant subtypes of meningioma and clinical outcome
Kwang-Won Ko1, Do-Hyun Nam, Doo-Sik Kong
1Department of Neurosurgery, Samsung Medical Center and Samsung Biomedical Research Institute, SungKyunKwan University School of Medicine, 50 Ilwon-Dong, Kangnam-ku, Seoul 135-710, Korea.
Abstract:
We evaluated the relationship between histological malignant subtypes (WHO grade II or III) of meningioma and clinical outcome. Of 485 patients treated surgically for intracranial meningioma at our hospital between 1994 and 2004, 49 (10%; 18 male, 31 female) had potentially malignant features. The histological tumor subtypes within this group of patients included: atypical (n=23); clear cell (n=3); chordoid (n=5); rhabdoid (n=16); and anaplastic (n=4). Correlations among prognosis, recurrence, and the following factors were analyzed for each histological subtype: the Simpson grade of surgical resection (grades I-III vs. grade IV), tumor location (convexity vs. other), the Ki-67 index, and use of postoperative radiotherapy. The median value of the Ki-67 index was 16.2% (range: 1.0-57.2%). The surgical resections were of Simpson grades I-III and IV in 43 and six of the 49 patients, respectively. Tumors recurred after the initial surgical resection in 14 of the 49 patients. In view of the relatively high proportion of malignant subtypes (10%), we suggest that all meningiomas should be evaluated for malignancy. The extent of surgical resection, the histological subtype, and the Ki-67 index can help to predict the clinical outcome for meningioma patients.
Insights
Malignant meningioma subtypes (WHO grade II or III) impact patient outcomes. Histological subtype, surgical resection extent, and Ki-67 index predict prognosis, suggesting all meningiomas warrant malignancy evaluation.
Area of Science:
- Neuropathology
- Neurosurgery
- Oncology
Background:
- Meningiomas are tumors arising from the meninges.
- Malignant meningiomas (WHO grade II or III) present distinct clinical challenges.
- Accurate prediction of clinical outcome is crucial for patient management.
Purpose of the Study:
- To evaluate the relationship between histological malignant meningioma subtypes and clinical outcomes.
- To identify factors predicting prognosis and recurrence in patients with potentially malignant meningiomas.
- To determine if all meningiomas should be assessed for malignancy.
Main Methods:
- Retrospective analysis of 485 intracranial meningioma patients treated surgically (1994-2004).
- Focus on 49 patients with potentially malignant features (atypical, clear cell, chordoid, rhabdoid, anaplastic subtypes).
- Correlated prognosis and recurrence with Simpson grade of resection, tumor location, Ki-67 index, and radiotherapy using statistical analysis.
Main Results:
- 10% of meningiomas exhibited potentially malignant features.
- Tumor recurrence occurred in 14 of 49 patients.
- The Ki-67 index median was 16.2% (range 1.0-57.2%).
- Simpson grades I-III resection was performed in 43 patients, grade IV in six.
- Extent of surgical resection, histological subtype, and Ki-67 index were predictive of clinical outcome.
Conclusions:
- A significant proportion of meningiomas may have malignant features, necessitating universal evaluation.
- Histological subtype, extent of surgical resection (Simpson grade), and Ki-67 index are key predictors of meningioma patient outcomes.
- These factors aid in predicting prognosis and recurrence, guiding treatment strategies for meningioma patients.