Histopathological predictors of progression-free survival in atypical meningioma: a single-center retrospective cohort and meta-analysis

• Published in: Brain tumor pathology Vol. 39; no. 2; pp. 99 - 110
• Main Authors: Kim, Min-Sung, Chun, Se-Woong, Dho, Yun-Sik, Seo, Youngbeom, Lee, Joo Ho, Won, Jae Kyung, Kim, Jin Wook, Park, Chul-Kee, Park, Sung-Hye, Kim, Yong Hwy
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.04.2022; Springer Nature B.V
• Subjects: Cancer Research; Classification; Cohort Studies; Disease-Free Survival; Drug dosages; Humans; Medical prognosis; Medicine; Medicine & Public Health; Meningeal Neoplasms - pathology; Meningioma - pathology; Meta-analysis; Necrosis; Neoplasm Recurrence, Local - diagnosis; Neurology; Neurosurgery; Oncology; Original Article; Pathology; Prognosis; Progression-Free Survival; Radiation therapy; Radiosurgery; Retrospective Studies; Surgery; Systematic review; Variables; Atypical meningioma; Prognostic factor; Recurrence; Gross total resection; Progression-free survival
• ISSN: 1433-7398; 1861-387X
• DOI: 10.1007/s10014-021-00419-w

To determine the prognostic significance of histopathological features included in the diagnostic criteria of atypical meningioma for progression-free survival (PFS). We performed a retrospective cohort study and meta-analysis. Brain invasion, mitotic index, spontaneous necrosis, sheeting, prominent nucleoli, high cellularity, and small cells were the histopathological features of interest. The data from 25 studies involving 3590 patients including our cohort ( n  = 262) were included. The pooled HR of mitotic index at a cutoff value of 4 showed no statical significance in the gross analysis (pooled HR, 1.09; 95% CI 0.61–1.96; p  = 0.7699). Furthermore, it failed to prognosticate PFS in other pooled analyses. For brain invasion, no consistent association with the progression was found in each pooled analysis according to the included studies. Among the remaining five atypical features, spontaneous necrosis, sheeting, and prominent nucleoli showed a significant correlation with PFS in the gross analysis. In the analysis that pooled the HRs from the multivariate analyses, only spontaneous necrosis had significant association with PFS. The available evidence supports that the current cutoff value of mitotic index for diagnosing atypical meningioma might be improper to have prognostic value. The prognostic significance of brain invasion also needs further evaluation.