title: Long Term Surgical Outcome and Prognostic Factors of Atypical and Malignant Meningiomas.
abstract: Atypical and malignant meningiomas are rare. Our aim was to examine the treatment outcomes following surgical resection, and analyze associations between clinical characteristics and overall survival (OS) or relapse free survival (RFS). 102 patients with atypical or malignant meningiomas underwent microsurgical resection between June 2001 and November 2009 were analyzed retrospectively. We compared demographics, clinical characteristics, treatment, and complications. The five-year and ten-year overall survival rates were 93.5% and 83.4%, respectively. Three factors significantly reduced OS: Malignant meningiomas (p < 0.001), which also decreased RFS (p < 0.001); female patients (p = 0.049), and patients with Karnofsky Performance Status (KPS) < 70 at diagnosis (p = 0.009). Fifty two patients (51%) experienced tumor relapse. Total resection of tumors significantly impacted RFS (p = 0.013). Tumors located at parasagittal and posterior fossa area lead to higher relapse rate (p = 0.004). Subtotal resection without adjuvant radiotherapy lead to the worst local control of tumor (p = 0.030). An MIB-1 index <8% improved OS and RFS (p = 0.003). Total resection of atypical and malignant meningiomas provided better outcome and local control. Adjuvant radiation therapy is indicated for patients with malignant meningiomas, with incompletely excised tumors; or with tumors in the parasagittal or posterior fossa area. The MIB-1 index of the tumor is an independent prognostic factor of clinical outcome.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Yu-Chi
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Chuang
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Wei
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Cheng-Nen
authors.initials: CN
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chieh-Tsai
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Yung-Hsin
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Tzu-Kan
authors.initials: TK
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Peng-Wei
authors.initials: PW
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Yin-Cheng
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chen-Kan
authors.initials: CK
authors.lastname: Tseng
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Radiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Yao-Liang
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: Pin-Yuan
authors.initials: PY
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome