Meningioma Recurrence and Postoperative Residual Tumor Location

Background: Meningiomas make up 39% of U.S. central nervous system tumors. 80% are Grade I with 47% recurrence; Grade II has 22 to 60%; Grade III’s rates are unspecified. Subtotal resection (STR), used in 30% of cases due to tumor constraints, correlates with increased recurrence. Studies have shown factors amplifying post-STR recurrence risk include preoperative tumor volume, preoperative falcine and tentorial tumor locations, and African American race. To date, the relationship between post-STR residual tumor locations and recurrence sites on recurrence incidence or duration to recurrence remains unknown.

Objective: Examine post-STR residual tumor location, and recurrence location as factors in predicting recurrence in patients with STR meningioma.

Methods: A retrospective cohort study of patients who underwent STR at Jefferson between 2011 and 2017. Data were transitioned from electronic health record to RedCAP to examine patient demographics, meningioma recurrence, time from STR to recurrence, residual locations (near blood vessel, nerve, brain, or dura), and recurrence locations. Analysis methods included multivariable regression.

Results: Among the 126 patients analyzed, a diverse range of tumor locations was observed, with cerebral convexity being the most common (31.7%), followed by falcine (23.0%) and parasagittal (21.4%) locations. Hypertension was the most prevalent associated medical condition (42.1%), and recurrence typically occurred around 18 months postsurgery with significant variability ([Table 1]). As seen in the multivariable regression analysis for recurrence ([Table 2]), the most significant predictors were tumor residual location along the skull base dura (Coefficient: −0.415, p = 0.0017), around the artery (coefficient: −0.602, p = 0.001538), and in proximity to the cranial nerve (coefficient: −0.600, p = 0.00456).

Conclusion: In conclusion, this study aimed to assess the impact of post-STR residual tumor location and recurrence site on recurrence risk in STR meningioma patients. Our findings suggest that tumor residuals along the skull base dura, near blood vessels, and close to cranial nerves are significant predictors of recurrence. This may guide therapeutic decisions such as patient selection for early radiation, and postoperative monitoring strategies.

Table 1

Table 2

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Artikel online veröffentlicht:
05. Februar 2024