title: Bone involvement predicts poor outcome in atypical meningioma.
abstract: OBJECTIVE
  The authors identified clinical features associated with progression and death in atypical meningioma (AM).
  
  
  METHODS
  Forty-seven cases of primary AM treated at Massachusetts General Hospital were retrospectively evaluated for clinical features. Associations with progression-free survival (PFS) and overall survival were assessed.
  
  
  RESULTS
  The estimated median PFS was 56 months (95% CI 35 months-not estimable). The overall 3- and 5-year PFS rates were 65% (95% CI 44-80%) and 48% (95% CI 26-67%), respectively. The median survival time and 5- and 10-year survival rates were 158 months (95% CI 103 months-not estimable), and 86% (95% CI 69-94%) and 61% (95% CI 35-79%), respectively. Subtotal resection was associated with increased rate of progression compared to gross-total resection (p=0.05) and trended toward an association with decreased survival (p=0.09). Bone involvement was associated with an increased rate of disease progression (p=0.001) and decreased survival (p=0.04). Bone involvement remained significantly associated with progression after Bonferroni adjustment for multiple comparisons (p=0.008) and in bivariate Cox regression models. Seventy-eight percent of patients with bone involvement at primary diagnosis had tumor recurrence within bone, whereas only 25% of patients without evidence of bone invasion at primary diagnosis experienced osseous recurrence.
  
  
  CONCLUSIONS
  Osseous involvement is associated with a poor outcome in patients with AMs; bone assessment is therefore extremely important. Further investigation is warranted to assess the effectiveness of bone resection and/or bone-directed radiation therapy in improving outcome.
authors.affiliation: Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. dgabeau@partners.org
authors.forename: Darlene
authors.initials: D
authors.lastname: Gabeau-Lacet
authors.forename: Manish
authors.initials: M
authors.lastname: Aghi
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Betensky
authors.forename: Fred G
authors.initials: FG
authors.lastname: Barker
authors.forename: Jay S
authors.initials: JS
authors.lastname: Loeffler
authors.forename: David N
authors.initials: DN
authors.lastname: Louis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008579:Meningioma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies