title: WHO grade II and III meningiomas: a study of prognostic factors.
abstract: Meningiomas represent one of the largest subgroups of intracranial tumors. They are generally benign, but may show a histological progression to malignancy. Grades II and III meningiomas have been less well studied and are not well controlled because of their aggressive behaviour and recurrences. There is no consensus on therapeutic strategies and no prognostic factors are known. In order to determine these parameters, a multi-institutional retrospective analysis was performed in France with the support of the Neuro-Oncology Club of the French Neurosurgical Society. This study was performed on 199 adults treated for WHO grade II (166 patients) or grade III (33 patients) meningiomas between 1990 and 2004 in the Neurosurgery Departments of five French University Hospitals. Data on epidemiology, clinical behaviour and therapy were collected. Overall survival and progression-free survival were analysed as a function of each possible prognostic factor. For patients with grade II meningiomas, the 5- and 10-year OS rates were 78.4 and 53.3%, respectively, while, for patients with grade III meningiomas, the corresponding values were 44.0 and 14.2%. For patients with grade II meningiomas, the 5- and 10-year PFS rates were 48.4 and 22.6%, respectively, the corresponding values for patients with grade III meningiomas being 8.4 and 0%. For the grade II meningiomas, univariate analysis showed that age < 60 years (P < 0.0001) and Simpson 1 resection (P = 0.055) were associated with a longer OS. For the grade III meningiomas, univariate analysis showed that age < 60 years (P < 0.0001) and RT (P = 0.036) were associated with a longer OS. Histological grade II was found to be associated with a longer PFS (P = 0.0032) and RT reduced the PFS in grade II meningiomas (P = 0.0006) There were no other prognostic factors in terms of PFS for grades II and III meningiomas in univariate analysis. Multivariate analysis confirmed that age (< 60 years), Simpson 1 and histological grade II were independent prognostic factors for survival. This retrospective study might improve the management of grades II and III meningiomas. Prospective trials should delineate strong therapeutic guidelines for high-grade meningiomas.
authors: Department of Neurosurgery D, Groupement Hospitalier Est, Hôpital Neurologique Wertheimer, 69677, Bron, France. anne.durand2@orange.fr.
authors: Anne
authors: A
authors: Durand
authors: Department of Neuropathology, CHU Dupuytren, 87000, Limoges, France.
authors: François
authors: F
authors: Labrousse
authors: Department of Neuropathology, Groupement Hospitalier Est, Hôpital Neurologique Wertheimer, 69677, Bron, France.|Inserm U482, Université de Lyon, Lyon1, UMR-S842, 69372, Lyon, France.
authors: Anne
authors: A
authors: Jouvet
authors: Department of Neurosurgery, Hôpital G. Chauliac, 34295, Montpellier, France.
authors: Luc
authors: L
authors: Bauchet
authors: Department of Neurosurgery, Hôpital Beaujon, 92118, Clichy, France.
authors: Michel
authors: M
authors: Kalamaridès
authors: Department of Neurosurgery, CHU, 49933, Angers, France.
authors: Philippe
authors: P
authors: Menei
authors: Department of Neurosurgery D, Groupement Hospitalier Est, Hôpital Neurologique Wertheimer, 69677, Bron, France.
authors: Robert
authors: R
authors: Deruty
authors: Department of Neurosurgery, CHU Dupuytren, 87000, Limoges, France.
authors: Jean Jacques
authors: JJ
authors: Moreau
authors: Inserm U482, Université de Lyon, Lyon1, UMR-S842, 69372, Lyon, France.
authors: Michelle
authors: M
authors: Fèvre-Montange
authors: Department of Neurosurgery D, Groupement Hospitalier Est, Hôpital Neurologique Wertheimer, 69677, Bron, France.
authors: Jacques
authors: J
authors: Guyotat
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008579:Meningioma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D014944:World Health Organization