Clinical outcome, tumor recurrence, and causes of death: a long-term follow-up of surgically treated meningiomas

Objective The medical literature still lacks information about the impacts 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. The paper evaluates these data taking into account tumor localization and histological 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 subjects was reviewed and 379 patients/families interviewed. Results Sixty-eight deaths were related to tumor treatment/progression and 36 from other causes. After two years of surgery, deaths not related to tumor were seven times more frequent than tumor-related deaths (odds ratio 7.1[95%CI 2.8 to 19.5] P value < 0.0001). Ten years survival was expected to 85% of grade I (GI), 35% of atypic (GII), and 0% of anaplastic (GIII) meningioma patients. Convexity tumors had about half the risk of recurrence compared to other localizations (odds ratio 0.4 [95% CI 0.27 to 0.67], P-value = 0.0002). In GI meningioma, recurrence was neither related to death nor with impairment of independent life. All patients with GII and GIII that had recurrence died. 96.3% of interviewees reported neurological improvement or stability after the surgery. Conclusion Histological grade is the most important factor for long-term survival. Complete resection has to be pursued in GII and GIII but must be carefully weighed against morbidities in GI meningioma.