Progressing-Free Survival and Prognostic Factors With Recurrence in 190 Patients With Primary Atypical Meningiomas.
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BACKGROUND: For atypical meningioma (AM), there is a high postoperative local recurrence rate. Although adjuvant radiotherapy has been practiced in patients with AM resection, its role remains controversial. In this study, progression-free survival (PFS) of AM patients was analyzed, and factors associated with postoperative recurrence were identified. METHODS: A total of 190 AM patients who visited our institutions and had surgery between September 2013 and July 2023 were retrospectively included in this study. Factors such as the extent of surgical resection, tumor location, brain invasion, bone invasion, and therapy modality (if radiotherapy was used or not) were analyzed. Recurrence-related prognostic factors were assessed with univariate and multivariate analyses. RESULT: The median PFS was 40.4 months (range: 6-108 months), Simpson grade I-II resection was achieved in 160 (84.2%) patients, and 22 (11.6%) patients received postoperative radiotherapy (RT). The median tumor size was 4.92 cm (range: 1.6-9.8 cm) and tumor size measured to be ≥ 5.0 cm in 94 patients. The tumor was located at the skull base for 48 patients (25.3%). During follow-up, tumor recurrence was observed in 40 (21.1%) patients. Multivariate Cox analysis showed that tumor size (hazard ratio = 2.292; P = 0.013), extent of resection (Simpson grade I-II vs. Simpson grade III-IV, hazard ratio = 4.112; P < 0.001), and skull base location (hazard ratio = 2.071; P = 0.032) were significant and independent predictors of tumor recurrence. The rate of tumor recurrence was 18.2% (4 of 22) for patients who received RT, and 21.4% (36 of 168) for patients did not receive RT. No significant association between longer PFS and postoperative radiotherapy was found, regardless the degree of resection (P = 0.332). CONCLUSIONS: Tumor size, extent of resection, and skull base location were powerful predictors for recurrence in AM patients. The risk of recurrence in AM patients might not be decreased by postoperative RT. Future studies on larger cohorts including AM patients combining advanced RT and chemotherapy are still needed.