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Risk Factors for High-Grade Meningioma in Brain and Spine: Systematic Review and Meta-analysis
Hong Kyung Shin1, Jin Hoon Park1, Young Hyun Cho1
1Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Background:
Histologic grade has important implications for the management in meningioma. It is important to understand the risk of high-grade meningioma (grades II and III). In this article, we systematically reviewed the histologic grade of meningioma depending on the location and sex and its relationship with recurrence.
Methods:
The PubMed and Embase databases were systematically searched until February 4, 2020. We included studies that were not restricted to specific anatomic locations, histologic grade, or the sizes of the tumors. The proportion of high-grade meningiomas depending on the location and sex and the odds ratio (OR) of recurrence were pooled using a random-effects model.
Results:
Outcome data were analyzed for 20,336 tumors from 34 studies. We found different proportions of high-grade meningiomas in the brain (12.8%) (95% confidence interval [CI], 10.5%-15.1%) versus the spine (2.4%) (95% CI, 1.0%-3.7%) (P < 0.01). Skull base meningiomas (8.7%) (95% CI, 5.8%-11.6%) had a lower proportion of high-grade meningiomas than non-skull base meningiomas (16.5%) (95% CI, 11.9%-21.1%) (P < 0.01). In addition, high-grade meningiomas were more likely to occur in male patients (18.0%) (95% CI, 10.1%-25.9%) than female patients (7.0%) (95% CI, 3.5%-10.6%) (P = 0.01). Higher rates of recurrence (OR = 13.83) were confirmed for high-grade meningiomas than grade I meningiomas (95% CI, 4.10-46.65) (P < 0.01).
Conclusions:
This meta-analysis found that intracranial, nonskull base, and male sex are risk factors for high-grade meningioma, and high-grade meningioma had a much higher recurrence rate as compared with grade I meningioma.
Insights
High-grade meningiomas (grades II and III) are more common in the brain and in males. These aggressive tumors have a significantly higher recurrence rate compared to grade I meningiomas.
Area of Science:
- Neuropathology
- Oncology
- Epidemiology
Background:
- Histologic grade is crucial for meningioma management.
- Understanding the risk factors for high-grade meningioma (grades II and III) is essential.
- Recurrence rates vary based on tumor grade and location.
Purpose of the Study:
- To systematically review the histologic grade of meningioma.
- To analyze the proportion of high-grade meningiomas based on tumor location and patient sex.
- To determine the relationship between histologic grade and meningioma recurrence.
Main Methods:
- Systematic search of PubMed and Embase databases up to February 4, 2020.
- Inclusion of studies regardless of anatomic location, histologic grade, or tumor size.
- Pooled analysis of high-grade meningioma proportions and odds ratios (OR) for recurrence using a random-effects model.
Main Results:
- Analysis of 20,336 tumors from 34 studies revealed higher high-grade meningioma proportions in the brain (12.8%) versus the spine (2.4%).
- Nonskull base meningiomas (16.5%) showed a higher proportion of high-grade tumors than skull base meningiomas (8.7%).
- High-grade meningiomas were more prevalent in males (18.0%) than females (7.0%) and had a significantly higher recurrence rate (OR = 13.83) compared to grade I meningiomas.
Conclusions:
- Intracranial location, nonskull base location, and male sex are identified as risk factors for high-grade meningioma.
- High-grade meningiomas exhibit a substantially increased risk of recurrence compared to grade I meningiomas.
- These findings aid in risk stratification and personalized management strategies for meningioma patients.
