title: Extent of resection and overall survival for patients with atypical and malignant meningioma.
abstract: BACKGROUND
  The prognosis for patients with atypical and malignant meningioma is guarded; whether the extent of resection is associated with survival-based outcomes in this population remains poorly defined. This study investigated the association between gross total resection (GTR) and all-cause mortality in patients with atypical and malignant meningioma.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results program was used to identify 575 and 64 patients betweens the ages of 18 and 70 years who were diagnosed with atypical and malignant meningioma, respectively, between 2004 and 2009. Multivariate Cox proportional hazards regression was used to assess the adjusted impact of GTR versus subtotal resection on all-cause mortality.
  
  
  RESULTS
  Baseline patient characteristics were similar for patients who did undergo GTR and patients who did not undergo GTR. The 5-year overall survival rates were 91.3% (95% confidence interval [CI], 86.2%-94.5%) and 78.2% (95% CI, 70.0%-84.3%) for patients with atypical meningioma who did and did not undergo GTR, respectively, and 64.5% (95% CI, 45.9%-78.1%) and 41.1% (95% CI, 17.9%-63.1%) for patients with malignant meningioma who did and did not undergo GTR, respectively. After adjustments for available, pertinent confounding variables, GTR was associated with lower all-cause mortality in patients with atypical (hazard ratio, 0.39; 95% CI, 0.23-0.67; P < .001) and malignant meningioma (hazard ratio, 0.35; 95% CI, 0.15-0.81; P = .01).
  
  
  CONCLUSIONS
  The extent of resection is a powerful predictor of outcome for patients with atypical and malignant meningioma. These data highlight the hazard associated with the presence of gross tumor bulk after surgery and suggest a value for more extensive resections that should be balanced against the additional potential morbidity.
authors: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Ayal A
authors: AA
authors: Aizer
authors: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Wenya Linda
authors: WL
authors: Bi
authors: Harvard Medical School, Boston, Massachusetts.
authors: Manjinder S
authors: MS
authors: Kandola
authors: Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Eudocia Q
authors: EQ
authors: Lee
authors: Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Lakshmi
authors: L
authors: Nayak
authors: Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Mikael L
authors: ML
authors: Rinne
authors: Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Andrew D
authors: AD
authors: Norden
authors: Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Rameen
authors: R
authors: Beroukhim
authors: Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: David A
authors: DA
authors: Reardon
authors: Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors: Patrick Y
authors: PY
authors: Wen
authors: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Ossama
authors: O
authors: Al-Mefty
authors: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Nils D
authors: ND
authors: Arvold
authors: Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Ian F
authors: IF
authors: Dunn
authors: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Brian M
authors: BM
authors: Alexander
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000601:surgery*; D008579:Meningioma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D018365:Neoplasm, Residual; D019635:Neurosurgical Procedures; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult
keywords: anaplastic; atypical; death; extent of resection; gross total; malignant; meningioma; mortality; surgery; survival