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Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features

Cited 164 time in Web of Science Cited 175 time in Scopus
Authors
Yang, S-Y; Park, C-K; Park, S-H; Kim, D G; Chung, Y S; Jung, H-W
Issue Date
2007-09-04
Publisher
BMJ Publishing Group
Citation
J Neurol Neurosurg Psychiatry 2008;79:574-580
Keywords
Brain/pathologyCombined Modality TherapyCranial IrradiationDisease ProgressionFollow-Up StudiesGene Expression Regulation, Neoplastic/geneticsKi-67 Antigen/geneticsMeningeal Neoplasms/classification/*diagnosis/pathology/surgeryMeningioma/classification/*diagnosis/pathology/surgeryNeoplasm Invasiveness/pathologyNeoplasm Recurrence, Local/classification/diagnosis/pathology/surgeryPrognosisRadiotherapy, AdjuvantSurvival RateTreatment OutcomeTumor Suppressor Protein p53/geneticsWorld Health Organization
Abstract
OBJECTIVES: To evaluate patient outcome and investigate the prognostic factors of high-grade meningiomas by adopting the 2000 World Health Organization (WHO) classification system. METHODS: Between 1986 and 2004, 74 patients were diagnosed with high-grade meningioma: 33 with atypical and 41 with anaplastic meningioma. The mean follow-up was 58.5 months. We reclassified all surgical specimens, according to the 2000 WHO classification system, using two expert neuropathologists. RESULTS: Forty of 74 meningiomas were reclassified as atypical meningioma and 24 as anaplastic meningioma. Overall and recurrence-free survivals were significantly longer in patients with atypical than in those with anaplastic meningioma: 142.5 versus 39.8 months and 138.5 versus 32.2 months, respectively (p<0.001). In patients with atypical meningiomas, brain invasion and adjuvant radiotherapy were not associated with survival; however, in the brain invasion subgroup, adjuvant radiotherapy improved patients' survival. In patients with anaplastic meningioma, the prognostic factors were brain invasion, adjuvant radiotherapy, malignant progression, p53 overexpression and extent of resection. The p53 overexpression was the only factor associated with malignant progression (p = 0.009). CONCLUSIONS: The 2000 WHO classification has identified the truly aggressive meningiomas better than did the previous criteria. A precise meningioma grading system may help to avoid over-treatment of patients with an atypical meningioma as, once the tumour has "declared itself" by recurrence and histological features, it becomes a tumour that is poorly amenable to current therapies.
ISSN
1468-330X (Electronic)
Language
English
URI
http://hdl.handle.net/10371/62023
DOI
https://doi.org/10.1136/jnnp.2007.121582
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College of Medicine/School of Medicine (의과대학/대학원)Neurosurgery (신경외과학전공)Journal Papers (저널논문_신경외과학전공)
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