Ayal A. Aizer1, Wenya Linda Bi2, Manjinder Singh Kandola3, Eudocia Q. Lee4, Lakshmi Nayak4, Mikael L. Rinne4, Andrew D. Norden4, Rameen Beroukhim4, David A. Reardon4, Patrick Y. Wen4, Ossama Al‐Mefty2, Nils D. Arvold1, Ian F. Dunn2, Brian M. Alexander1
1Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
2Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
3Harvard Medical School, Boston, Massachusetts
4Center for Neuro‐Oncology, Dana‐Farber Cancer Institute Boston Massachusetts
Tóm tắt
BACKGROUNDThe 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.METHODSThe 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.RESULTSBaseline 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).CONCLUSIONSThe 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. Cancer 2015;121:4376–81. © 2015 American Cancer Society.
