Health-related quality-of-life outcomes in CNS WHO grade 2 and 3 meningioma: a systematic review

WHO grade 2 and 3 meningioma constitute approximately 20% of all meningioma. The lower incidence of these more aggressive meningiomas has led to under-representation of clinical outcomes in the literature. It is hypothesised that patients with grade 2 or 3 meningiomas are disabled by tumour and treatment morbidity, contributing to lower health-related quality-of-life (HRQoL). A PRISMA-compliant systematic review was conducted (PROSPERO CRD42023441009). MEDLINE, EMBASE, and Cochrane Library databases were searched between inception and September 2023. Studies of adults (> 16 y.o.) with histologically-proven WHO grade 2 and 3 cranial meningioma who underwent a combination of surgery, radiotherapy, and stereotactic radiosurgery and had HRQoL outcome data were included. Primary outcome was HRQoL. Fifteen studies were included. HRQoL was measured with 10 different tools, three of which have been validated in meningioma patients. Only two studies exclusively reported on WHO grade 2 and 3 meningioma and four further studies considered WHO grade in statistical analysis. WHO grade 2 and 3 meningioma were associated with reduced HRQoL in two studies that reported direct comparison and no difference in another two. Psychological domains were reduced in most studies compared to normative data or controls including in one of the two studies reporting on WHO grade 2 and 3 tumours exclusively. This systematic review highlights the need for prospective studies of more patients with grade 2 and 3 meningioma with validated meningioma-specific HRQoL tools. The current literature is limited by the small proportion of patients within reported studies, and heterogenous and poorly reported management paradigms.