Atypical and anaplastic meningiomas in a public hospital in São Paulo State, Brazil

Colli, Benedicto Oscar; Carlotti Junior, Carlos Gilberto; Assirati Junior, João Alberto; Coelho Junior, Vicente de Paulo Martins; Neder, Luciano

doi:10.1590/0004-282X20150106

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Articles • Arq. Neuro-Psiquiatr. 73 (9) • Sept 2015 • https://doi.org/10.1590/0004-282X20150106 copy

Atypical and anaplastic meningiomas in a public hospital in São Paulo State, Brazil

Meningiomas atípicos e anaplásicos em um hospital público de São Paulo, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Atypical/anaplastic (World Health Organization (WHO) grades II and III) are less common and have poorer outcomes than benign meningiomas. This study aimed to analyze the outcome of patients with these tumors.

Method

Overall/recurrence-free survivals (RFS) and the Karnofsky Performance Scale of 52 patients with grades II (42) and III (9) meningiomas surgically treated were analyzed (uni/multivariate analysis).

Results

Total/subtotal resections were 60.8%/35.3%. Patients <60 years-old and grade II tumors had longer survival. Grade II tumors, total resection andde novo meningioma had better RFS (univariate analysis). Patients >60 years-old, de novo meningioma and radiotherapy had longer survival and patients <60 years-old and with grade II tumors had longer RFS (multivariate analysis). Recurrence rate was 51% (39.2% Grade II and 66.7% Grade III). Operative mortality was 1.9%.

Conclusion

Age <60 years-old, grade II tumors and de novomeningiomas were the main predictors for better prognosis among patients with grades II and III meningiomas.

atypical and anaplastic meningiomas; surgical treatment; extent of resection; survival curves; recurrence survival curves

Location		WHO Histopathological Grades
Location		Grade II	Grade III	Total
Parasagittal	Anterior Third	04		04
	Middle Third	06	01	07
	Posterior Third	01		01
Convexity	Fronto-Parietal	02	02	02
	Fronto-Temporal	01	02	03
	Parietal	04		04
Sphenoid Wing	Internal Third	02		02
Sphenoid Wing	Middle Third	01		01
Diafragma Selae			01	01
Falx	Anterior Third	02		02
Falx	Middle Third	01		01
Falco-Tentorial		01		01
Middle Fossa		02		02
Olfactory Groove		02		02

Characteristic	Grade II Meningiomas atypical	Grade II Meningiomas other	Grade II Meningiomas total	Grade III Meningiomas	Total
Sex
Female	22	5	27	4	31
Male	15	1	16	5	21
Female/male	1.5:1	5:1	1.7:1	0.8:1	1.5:1
Age (yrs)*	53.95 ± 14.70	53.33 ± 21.32	53.86 ± 15.47	75.22 ± 7.546	54.77 ± 15.91
Age range (yrs)	17-76	25-81	16-81	31-89	16-89
Female	25-64	65-68	25-68	69-81	25-81
Male	16-62	65-65	16-25	67-89	16-89
Follow-up (months)*	66.59 ± 59.85	59.17 ± 41.00	65.23 ± 57.56	78.25 ± 74.52	69.78 ± 74.20

Histological grade	OMS II	OMS III	Total
Motor deficit	9 (21.4%)	0	9 (17.7%)
Cranial nerve deficits	9 (21.4%)	3 (22.2%)	12 (23.5%)
Seizures	8 (19.1%)	1 (11.1%)	9 (17.7%)
Protusion of the skull	5 (11.9%)	0	3 (05.9%)
Intracranial hypertension	4 (09.5%)	1 (11.1%)	4 (07.8%)
Superior cortical function deficits	3 (71.4%)	0	4 (07.8%)
Headache	3 (71.4%)	2 (22.2%)	3 (05.9%)
Incidental	1 (02.4%)	2 (22.2%)	5 (09.8%)
Total	42	9	51

	5y RFE	10y RFE	Median survival	Analysis
Age
Decades of life	-	-	-	p = 0,1012, log-rank test, df = 7
>60 years-old	85.7 vs 56.2%	75.0 vs 42.1%	-	p = 0.0212*, log-rank test, df = 1
Sex (female vs male)
All patients	73.7 vs 63.1%	55.3 vs 47.7%	Undef vs 136.0y	p = 0.6511, log-rank test, df = 1
Grade II	73.0 vs 78.4%	58.4 vs 58.8%	Undef vs Undef	p = 0.7281, log-rank test, df = 1
Grade III	50.0 vs 0.0%	50.0 vs 0.0%	147.0 vs 36.0y	p = 0.3261, log-rank test, df = 1
WHO Histopathological grade
G II, G II-atypical, G II-other subtype, G III)	75.7 vs 75.1%	51.1 vs 47.7%	-	p = 0.5823, log-rank test, df = 3
All Patients(G II vs G III)	85.7 vs 56.2%	75.0 vs 42.1%	184.0 vs 92.0y	p = 0,0221*, log-rank test, df =1
De Novo vs malignant progression	72.9 vs 46.9%	63.0 vs 31.3%	Undef vs 96.0y	p = 0.1955, log-rank test, df = 1
Extent of resection (radical, subtotal)
Grades II and III	82.8 vs 61.4%	63.1 vs 40.9%	Undef vs 96.0y	p = 0.2322, log-rank test, df = 2
Grade II	88.4 vs 61.0%	64.4 vs 61.0%	Undef vs Undef	p = 0.6880, log-rank test, df = 1
Grade III	50.0 vs 30.0%	50.0 vs 30.0%	111.0 vs 96.0y	p = 0.6823, log-rank test, df = 1
RT After 1^st surgery (RT vs No RT	52.7 vs 78.6%	52.7 vs 62.8%	186.0y vs Undef	p = 0,6698, log-rank test, df = 1
KPS at admittance (≤70 vs >70)	74.3 vs 75.8%	37.1 vs 65.0%	96.0 vs Undef	p = 0.5267. log-rank test, df = 1

	5y RFE	10yr RFE	Median Survival	Analysis
Recurrence/Regrowing rate GII vs G III (46.5% vs 66.7%)	-	-	-	p = 0.4654, Fisher’s exact test
Age
Decades of life	-	-	-	p = 0.7799, log-rank test, df = 7
>60 years-old	45.9 vs 53.0%	25.5 vs 12.9%	48.0 vs 84.0y	p = 0.9469, log-rank test, df = 1
WHO Histopathological grade
Grades (II vs III)	55.1% vs 0.0%	32.1 vs 0.0%	78.0 vs 15.0y	p < 0.0030*, log-rank test, df = 1
AtypicaI vs other subtypes G II	52.1 vs 10.5%	26.0 vs 32.5%	72.0 vs Undef	p < 0.2033, log-rank test, df = 1
De Novo vs Malignant progression	51.1 vs 0.0%	31.8 vs 0.0%	72.0 vs 15.0y	p = 0.0010*, log-rank test, df = 1
Sex
All patients,	53.7 vs 32.2%	25.6 vs 32.2%	72.0 vs 45.0%	p = 0.7396, log-rank test, df = 1
Patients with grade II	64.3 vs 32.5%	30.6 vs 32.5%	78.0 vs 45.0y	p = 0.5612, log-rank test, df = 1
Patients with grade III	0.0 vs 0.0%	0.0 vs 0.0%	15.0 vs 29.0y	p = 0.7675, log-rank test, df = 1
Extent of resection (radical, subtotal)
All patients	65.4 vs 33.0%	46.5 vs 0.0%	-	p = 0.011*9 log-rank test, df = 1
Patients with grade II	64.8 vs 45.5%	42.6 vs 15.4%	132.0 vs 36.0y	p = 0.2968, log-rank test, df = 1
Patients with grade III	0.0 vs 0.0%	0.0 vs 0.0%	11.5 vs 32.5y	p = 0.3948, log-rank test, df = 1
RT After 1^st surgery (RT x No RT)	29.2 vs 57.4%	29.2 vs 0.0%	36.0 vs 72.0y	p = 0.4895, log-rank test, df = 1
KPS at admittance (≤70 vs >70)	31.1 vs 54.9%	15.6 vs 27.4%	39.0 vs 78.0y	p = 0.4719 log-rank test, def = 1

Functional status	KPS Score	WHO Histopathological Grade
		Preoperative			Immediate Postoperative			Follow-Up
		Grade II	Grade III	Total	Grade II	Grade III	Total	Grade II	Grade III	Total
No. of patients		43	09	52	43	09	52	39	08	47
Normal/minimal symptoms & working	80-100	31 (72.1%)	06 (66.7%)	37 (71.1%)	29(67.4%)	6 (66.7%)	35 (67.3%)	31 (79.5%)	6 (66.7%)	37 (78.7%)
Independent, not working	70	12 (27.9%)	03 (33.3%)	15 (28.9%)	14 (32.6%)	2 (22.2%)	16 (30.8%)	08 (20.5%)	2 (22.2%)	10 (21.3%)
Moderate or severe disability	<70					1 (11.1%)	1 (1.9%)

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[1] Correspondence: Benedicto Oscar Colli; HCFMRP-USP, Divisão de Neurocirurgia, Departamento de Cirurgia, Campus Universitário USP; 14048-900 Ribeirão Preto SP, Brasil; E-mail: bocolli@fmrp.usp.br