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Necrosis is a consistent factor to recurrence of meningiomas: should it be a stand-alone grading criterion for grade
Pedro Góes1, Bruno Fernandes Oliveira Santos2, Fernando Seiji Suzuki2
1Department of Neurosurgery, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, Brazil. pedrogoes.ncr@gmail.com.
Abstract:
The purpose of this study was to evaluate spontaneous necrosis as a possible isolated factor for progression and recurrence in grade I meningiomas classified according to the current World Health Organization (WHO) classification. Meningiomas are the most frequently reported primary intracranial tumours, accounting for more than 35%. The 2016 WHO classification of central nervous system tumors stratifies meningiomas in grades I (benign), II (atypical), and III (malignant), according to histopathological aspects and the risk of progression or recurrence. Among 110 patients with intracranial meningiomas, 70 were WHO grade I meningiomas with no findings of atypia (G1WON), 15 were WHO grade I with necrosis (G1WN), 21 were WHO grade II (G2), and 4 were WHO grade III (G3). The mean follow-up was 5.9 ± 0.2 years. High performance scale (KPS ≥ 80) was different (p < 0.001) between WHO grade I meningiomas without (81.4%) and with (60%) necrosis. The 5-year mortality rate was 1.4, 6.7 and 5.9% for G1WON, G1WN and G2, respectively, with significant difference (p = 0.011) related to the presence of necrosis. The risk of recurrence was 3.7 times higher in G1WN than in G1WON (p = 0.017), and 4.2 times in G2 (p = 0.010). Progression-free survival (PFS) was clearly higher in patients with G1WON compared to G1WN and G2 (p = 0.002 and p < 0.001, respectively). There was no significant difference in PFS between G1WN and G2 (p = 0.692). Retreatment was also superior in meningioma with necrosis. Our findings provide clear statistical data to consider that patients with benign meningiomas and histologic findings of spontaneous necrosis are at increased risk of progression and recurrence compared to those with benign lesion without atypical features. Statistical analysis curves also suggest that these lesions behave more similarly to those currently classified as WHO grade II meningioma.
Insights
Spontaneous necrosis in grade I meningiomas increases the risk of tumor progression and recurrence, suggesting these benign tumors may behave like higher-grade lesions. This finding impacts patient risk assessment and treatment strategies for intracranial tumors.
Area of Science:
- Neuropathology
- Oncology
- Neurosurgery
Background:
- Meningiomas are common primary intracranial tumors, accounting for over 35% of all such neoplasms.
- The World Health Organization (WHO) classification (2016) grades meningiomas I, II, and III based on histopathological features and recurrence risk.
- Spontaneous necrosis is a histological finding that warrants further investigation for its impact on tumor behavior.
Purpose of the Study:
- To investigate spontaneous necrosis as an independent factor influencing progression and recurrence in World Health Organization (WHO) grade I meningiomas.
- To compare the clinical behavior of WHO grade I meningiomas with and without necrosis to other grades.
- To provide statistical data for risk stratification in benign meningiomas.
Main Methods:
- Retrospective analysis of 110 patients with intracranial meningiomas, categorized into WHO grade I without atypia (G1WON), WHO grade I with necrosis (G1WN), WHO grade II (G2), and WHO grade III (G3).
- Mean follow-up of 5.9 years.
- Statistical comparison of progression-free survival (PFS), mortality rates, and retreatment necessity between groups.
Main Results:
- Patients with WHO grade I meningiomas with necrosis (G1WN) showed a significantly higher risk of recurrence (3.7 times) and mortality compared to those without necrosis (G1WON).
- Progression-free survival (PFS) was significantly lower in G1WN and G2 groups compared to G1WON.
- The behavior of G1WN lesions was statistically similar to G2 meningiomas, indicating a potentially more aggressive nature than initially classified.
Conclusions:
- Histological evidence of spontaneous necrosis in grade I meningiomas is associated with an increased risk of progression and recurrence.
- These findings suggest that benign meningiomas with necrosis may exhibit behavior patterns similar to WHO grade II meningiomas.
- The presence of necrosis should be considered in the prognostic evaluation and treatment planning for patients with grade I meningiomas.
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