title: Clinical Outcome, Tumor Recurrence, and Causes of Death: A Long-Term Follow-Up of Surgically Treated Meningiomas.
abstract: OBJECTIVE
  The medical literature still lacks information about the impact of surgery and adjuvant treatment on the life of patients with meningioma. The clinical outcome, timing of tumor recurrence, and causes of death are often overlooked. This study evaluates these data taking into account tumor localization and histologic grade.
  
  
  METHODS
  The article is a cross-sectional study of patients operated on between 2000 and 2014 in a single institution. The series has 593 adult patients (442 females and 151 males) and follow-up of 68.8 ± 48.9 months. Imaging of 434 patients was reviewed and 379 patients/families interviewed.
  
  
  RESULTS
  Sixty-eight deaths were related to tumor treatment/progression and 36 to other causes. After 2 years of surgery, deaths not related to tumor were 7 times more frequent than were tumor-related deaths (odds ratio, 7.1; 95% confidence interval, 2.8-19.5; P < 0.0001). Ten-year survival was expected in 85% of patients with grade I (GI) meningioma, 35% of patients with atypic (GII) meningioma, and 0% of patients with anaplastic (GIII) meningioma. Convexity tumors had about half the risk of recurrence compared with other localizations (odds ratio, 0.4; 95% confidence interval, 0.27-0.67; P = 0.0002). In GI meningioma, recurrence was neither related to death nor to impairment of independent life. All patients with GII and GIII meningioma who had recurrence died. 96.3% of interviewees reported neurologic improvement or stability after the surgery.
  
  
  CONCLUSIONS
  Histologic grade is the most important factor for long-term survival. Complete resection has to be pursued in GII and GIII meningioma but must be carefully weighed against morbidities in GI meningioma.
authors.affiliation: Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; Divisão de Neurocirurgia Funcional IPQ, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil. Electronic address: almeida@hc.fm.usp.br.
authors.forename: Antonio Nogueira
authors.initials: AN
authors.lastname: de Almeida
authors.affiliation: Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Benedito Jamilson Araújo
authors.initials: BJA
authors.lastname: Pereira
authors.affiliation: Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Paulo Henrique
authors.initials: PH
authors.lastname: Pires Aguiar
authors.affiliation: Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Wellingson Silva
authors.initials: WS
authors.lastname: Paiva
authors.affiliation: Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; Divisão de Neurocirurgia Funcional IPQ, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Hector Navarro
authors.initials: HN
authors.lastname: Cabrera
authors.affiliation: Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Clemar Corrêa
authors.initials: CC
authors.lastname: da Silva
authors.affiliation: Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Departamento de Neurologia, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Suely Kazue Nagahashi
authors.initials: SKN
authors.lastname: Marie
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D003430:Cross-Sectional Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality* / Q000601:surgery*; D008579:Meningioma / Q000401:mortality* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Meningioma; Prognostic; Progression-free survival