title: Imaging and extent of surgical resection predict risk of meningioma recurrence better than WHO histopathological grade.
abstract: Risk stratification of meningiomas by histopathological grade alone does not reliably predict which patients will progress/recur after treatment. We sought to determine whether preoperative imaging and clinical characteristics could predict histopathological grade and/or improve prognostication of progression/recurrence (P/R).
  
  
  
  We retrospectively reviewed preoperative MR and CT imaging features of 144 patients divided into low-grade (2007 WHO grade I; n = 118) and high-grade (2007 WHO grades II/III; n = 26) groups that underwent surgery between 2002 and 2013 (median follow-up of 49 months).
  
  
  
  Multivariate analysis demonstrated that the risk factors most strongly associated with high-grade histopathology were male sex, low apparent diffusion coefficient (ADC), absent calcification, and high peritumoral edema. Remarkably, multivariate Cox proportional hazards analysis demonstrated that, in combination with extent of resection, ADC outperformed WHO histopathological grade for predicting which patients will suffer P/R after initial treatment. Stratification of patients into 3 risk groups based on non-Simpson grade I resection and low ADC as risk factors correlated with the likelihood of P/R (P < .001). The high-risk group (2 risk factors; n = 39) had a 45% cumulative incidence of P/R, whereas the low-risk group (0 risk factors; n = 31) had no P/R events at 5 years after treatment. Independent of histopathological grade, high-risk patients who received adjuvant radiotherapy had a lower 5-year crude rate of P/R than those without (17% vs 59%; P = .04).
  
  
  
  Patients with non-Simpson grade I resection and low ADC meningiomas are at significantly increased risk of P/R and may benefit from adjuvant radiotherapy and/or additional surgery.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: William L
authors.initials: WL
authors.lastname: Hwang
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Ariel E
authors.initials: AE
authors.lastname: Marciscano
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Anat O
authors.initials: AO
authors.lastname: Stemmer-Rachamimov
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: William T
authors.initials: WT
authors.lastname: Curry
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Fred G
authors.initials: FG
authors.lastname: Barker
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Robert L
authors.initials: RL
authors.lastname: Martuza
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Jay S
authors.initials: JS
authors.lastname: Loeffler
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Oh
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Helen A
authors.initials: HA
authors.lastname: Shih
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (W.L.H.); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., A.N., D.K., J.S.L., K.S.O., H.A.S.); Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts (W.L.H., M.L.); Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (A.E.M.); Harvard Business School Leadership Fellows Program, Boston, Massachusetts (D.K.); Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (A.O.S.-R.); Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (W.T.C., F.G.B., R.L.M.).
authors.forename: Mykol
authors.initials: M
authors.lastname: Larvie
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008579:Meningioma / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014944:World Health Organization
keywords: Simpson grade; apparent diffusion coefficient; histopathological grade; meningioma; radiotherapy