title: Long-term survival analysis of atypical meningiomas: survival rates, prognostic factors, operative and radiotherapy treatment.
abstract: BACKGROUND
  The rarity and the inconsistent criteria for defining atypical meningioma prior to the WHO 2007 classification made its management and prognostic factors poorly understood. Only few articles have addressed the survival rates of WHO-classified atypical meningiomas. The small number or the disproportionate representation of irradiated patients was a weakness for these articles. This study evaluated whether the extent of surgery and receiving adjuvant radiotherapy after an initial operation along with other patient characteristics influenced the recurrence and survival rates of atypical meningiomas.
  
  
  METHODS
  The clinical and surgical notes of the 79 patients with grade II atypical meningioma treated at our center over 13 years were retrospectively evaluated. The histology grading was consistent with WHO 2007 classification. The Simpson grading system was used to assess the extent of surgical resection. Kaplan Meier analysis, Cox multivariate regression analysis, and the Log-rank test were conducted using STATA® statistical package.
  
  
  RESULTS
  The average age at the time of initial operation was 58 years, and 54 % were males. The mean follow-up period was 50 months. In Cox multivariate analysis, only Simpson grading was predictive of recurrence (hazard ratio = 2.22 / 1 increase in Simpson grade. p = 0.003). Simpson grade I patients had a relapse-free survival rate of 97 and 74 % at one and five years, respectively, compared with 88 and 32 % in the subtotal resection group (Simpson grades II to IV). There was no statistically significant correlation between recurrence and subjecting patients to postoperative radiotherapy. Apart from Simpson grade I patients, there was a general trend for worse outcome in irradiated patients.
  
  
  CONCLUSIONS
  The most important prognostic factor in determining recurrence was Simpson grading. There was no statistically significant impact of adjuvant radiotherapy on the recurrence of atypical meningiomas. Meta-analysis for the existing literature is needed.
authors: Neurosurgery Department, The Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, L9 7LJ, Merseyside, UK, s.hammouche@doctors.org.uk.
authors: Salah
authors: S
authors: Hammouche
authors: Simon
authors: S
authors: Clark
authors: Alex Hie Lin
authors: AH
authors: Wong
authors: Paul
authors: P
authors: Eldridge
authors: Jibril Osman
authors: JO
authors: Farah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D008579:Meningioma / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery; D019635:Neurosurgical Procedures; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult