title: Survival in patients treated for anaplastic meningioma.
abstract: OBJECTIVE
  While most meningiomas are benign, 1%-3% display anaplastic features, with little current understanding regarding the molecular mechanisms underlying their formation. In a large single-center cohort, the authors tested the hypothesis that two distinct subtypes of anaplastic meningiomas, those that arise de novo and those that progress from lower grade tumors, exist and exhibit different clinical behavior.
  
  
  METHODS
  Pathology reports and clinical data of 37 patients treated between 1999 and 2012 for anaplastic meningioma at Memorial Sloan-Kettering Cancer Center (MSKCC) were retrospectively reviewed. Patients were divided into those whose tumors arose de novo and those whose tumors progressed from previously documented benign or atypical meningiomas.
  
  
  RESULTS
  Overall, the median age at diagnosis was 59 years and 57% of patients were female. Most patients (38%) underwent 2 craniotomies (range 1-5 surgeries) aimed at gross-total resection (GTR; 59%), which afforded better survival when compared with subtotal resection according to Kaplan-Meier estimates (median overall survival [OS] 3.2 vs 1.3 years, respectively; p = 0.04, log-rank test). Twenty-three patients (62%) presented with apparently de novo anaplastic meningiomas. Compared with patients whose tumors had progressed from a lower grade, those patients with de novo tumors were significantly more likely to be female (70% vs 36%, respectively; p = 0.04), experience better survival (median OS 3.0 vs 2.4 years, respectively; p = 0.03, log-rank test), and harbor cerebral hemispheric as opposed to skull base tumors (91% vs 43%, respectively; p = 0.002).
  
  
  CONCLUSIONS
  Based on this single-center experience at MSKCC, anaplastic meningiomas, similar to glial tumors, can arise de novo or progress from lower grade tumors. These tumor groups appear to have distinct clinical behavior. De novo tumors may well be molecularly distinct, which is under further investigation. Aggressive GTR appears to confer an OS advantage in patients with anaplastic meningioma, and this is likely independent of tumor progression status. Similarly, those patients with de novo tumors experience a survival advantage likely independent of extent of resection.
authors: Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut; and 
authors: Jennifer
authors: J
authors: Moliterno
authors: Departments of 2 Neurosurgery.
authors: William P
authors: WP
authors: Cope
authors: Departments of 2 Neurosurgery.
authors: Emma D
authors: ED
authors: Vartanian
authors: Epidemiology and Biostatistics, and.
authors: Anne S
authors: AS
authors: Reiner
authors: Departments of 2 Neurosurgery.
authors: Roselyn
authors: R
authors: Kellen
authors: Departments of 2 Neurosurgery.
authors: Shahiba Q
authors: SQ
authors: Ogilvie
authors: Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Jason T
authors: JT
authors: Huse
authors: Departments of 2 Neurosurgery.
authors: Philip H
authors: PH
authors: Gutin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008577:Meningeal Neoplasms / Q000145:classification / Q000401:mortality* / Q000601:surgery*; D008579:Meningioma / Q000145:classification / Q000401:mortality* / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: CI = confidence interval; GTR = gross-total resection; MSKCC = Memorial Sloan–Kettering Cancer Center; OS = overall survival; STR = subtotal resection; anaplastic meningioma; oncology; outcome; survival