Factors Affecting Patient Outcomes of Atypical Meningiomas in a Modern Cohort

Introduction: While numerous studies have examined benign meningiomas, few have evaluated the outcomes of high grade meningiomas following the revision of the World Health Organization (WHO) diagnostic criteria. In this study, we have evaluated a modern cohort of patients with high grade meningiomas to identify prognostic factors for survival. Methods: A retrospective review was performed on patients diagnosed with WHO grade II or grade III intracranial meningiomas treated between 2004 and 2013. Various patient, tumor, and treatment characteristics were collected and analyzed to evaluate their impact on survival. Results: A total of 87 patients were included in the analysis. The median age was 58.5 years, with the cohort having a female predominance (51.7%). The median tumor size was 4.2 cm. Gross total resection was achieved in 60.9% of cases and did not affect patient outcomes (5-year survival: 75.0 vs. 56.3%, p = 0.21). Postoperative complications were noted in 26.6% of the patients. The patients also received chemotherapy (30.2%) and/or radiotherapy (39.5%), neither of which affected survival (p = 0.88 and p = 0.30, respectively). Patients with grade III meningiomas had significantly worse outcomes compared with those with grade II tumors (5-year survival: 73.5 vs. 20.0%, p = 0.018). Overall 2- and 5-year survival rates were 91 and 67.5%, respectively. On multivariate analysis, preoperative weakness (HR, 3.73; 95% CI, 1.23–11.3; p = 0.020) and grade III pathology (HR, 8.35; 95% CI, 3.18–15.9; p = 0.0011) significantly affected survival, whereas postoperative radiotherapy approached significance (HR, 0.20; 95% CI, 0.03–1.28; p = 0.090). Conclusion: Patients with high grade meningiomas have an overall poor prognosis, with those presenting with weakness having worse survival. However, the use of adjuvant radiation therapy may provide a survival benefit and requires further study.