Prognostic factors for survival in patients with high-grade meningioma and recurrence-risk stratification for application of radiotherapy

Shigeru Yamaguchi, Shunsuke Terasaka, Hiroyuki Kobayashi, Katsuyuki Asaoka, Hiroaki Motegi, Hiroshi Nishihara, Hiromi Kanno, Rikiya Onimaru, Yoichi M. Ito, Hiroki Shirato, Kiyohiro Houkin

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Radiotherapy for high-grade meningioma (HGM) is one of the essential treatment options for disease control. However, appropriate irradiation timing remains under debate. The object of this study is to discern which prognostic factors impact recurrence in HGM patients and to propose a risk-stratification system for the application of postoperative radiotherapy. Methods: We retrospectively reviewed 55 adult patients who were diagnosed with Grade II and III intracranial meningioma. Cox regression models were applied to the analysis for impact on early recurrence in HGM patients without postoperative radiotherapy. Results: Grade III malignancy (P = 0.0073) and transformed histology (P = 0.047) proved to be significantly poor prognostic factors of early recurrence by multivariate analysis. The other candidates for recurrence factors were Simpson Grade 3-5 resection, preoperative Karnofsky Performance status < = 70%, and MIB-1 labeling index > = 15%. According to these prognostic factors, postoperative HGM patients could be stratified into three recurrence-risk groups. The prognoses were significantly different between each group, as the 3-year actual recurrence-free rates were 90% in low-risk group, 31% in intermediate-risk group, and 15% in high-risk group. Conclusion: We propose recurrence-risk stratification for postoperative HGM patients using clinically available factors. Our results suggest that the prognosis for patients with high-risk HGMs is dismal, whereas HGM patients belonging to the lowrisk group could have favorable prognoses. This stratification provides us with the criteria necessary to determine whether to apply adjuvant radiotherapy to postoperative HGM patients, and to also help identify potentially curable HGMs without adjuvant radiotherapy.

Original languageEnglish
Article numbere97108
JournalPloS one
Volume9
Issue number5
DOIs
Publication statusPublished - 2014 May 12
Externally publishedYes

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Radiotherapy
Meningioma
radiotherapy
Recurrence
Survival
risk groups
prognosis
Adjuvant Radiotherapy
adjuvants
Disease control
Histology
Karnofsky Performance Status
resection
Proportional Hazards Models
histology
multivariate analysis
Irradiation
disease control
Multivariate Analysis
irradiation

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Prognostic factors for survival in patients with high-grade meningioma and recurrence-risk stratification for application of radiotherapy. / Yamaguchi, Shigeru; Terasaka, Shunsuke; Kobayashi, Hiroyuki; Asaoka, Katsuyuki; Motegi, Hiroaki; Nishihara, Hiroshi; Kanno, Hiromi; Onimaru, Rikiya; Ito, Yoichi M.; Shirato, Hiroki; Houkin, Kiyohiro.

In: PloS one, Vol. 9, No. 5, e97108, 12.05.2014.

Research output: Contribution to journalArticle

Yamaguchi, S, Terasaka, S, Kobayashi, H, Asaoka, K, Motegi, H, Nishihara, H, Kanno, H, Onimaru, R, Ito, YM, Shirato, H & Houkin, K 2014, 'Prognostic factors for survival in patients with high-grade meningioma and recurrence-risk stratification for application of radiotherapy', PloS one, vol. 9, no. 5, e97108. https://doi.org/10.1371/journal.pone.0097108
Yamaguchi, Shigeru ; Terasaka, Shunsuke ; Kobayashi, Hiroyuki ; Asaoka, Katsuyuki ; Motegi, Hiroaki ; Nishihara, Hiroshi ; Kanno, Hiromi ; Onimaru, Rikiya ; Ito, Yoichi M. ; Shirato, Hiroki ; Houkin, Kiyohiro. / Prognostic factors for survival in patients with high-grade meningioma and recurrence-risk stratification for application of radiotherapy. In: PloS one. 2014 ; Vol. 9, No. 5.
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AU - Kobayashi, Hiroyuki

AU - Asaoka, Katsuyuki

AU - Motegi, Hiroaki

AU - Nishihara, Hiroshi

AU - Kanno, Hiromi

AU - Onimaru, Rikiya

AU - Ito, Yoichi M.

AU - Shirato, Hiroki

AU - Houkin, Kiyohiro

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N2 - Background: Radiotherapy for high-grade meningioma (HGM) is one of the essential treatment options for disease control. However, appropriate irradiation timing remains under debate. The object of this study is to discern which prognostic factors impact recurrence in HGM patients and to propose a risk-stratification system for the application of postoperative radiotherapy. Methods: We retrospectively reviewed 55 adult patients who were diagnosed with Grade II and III intracranial meningioma. Cox regression models were applied to the analysis for impact on early recurrence in HGM patients without postoperative radiotherapy. Results: Grade III malignancy (P = 0.0073) and transformed histology (P = 0.047) proved to be significantly poor prognostic factors of early recurrence by multivariate analysis. The other candidates for recurrence factors were Simpson Grade 3-5 resection, preoperative Karnofsky Performance status < = 70%, and MIB-1 labeling index > = 15%. According to these prognostic factors, postoperative HGM patients could be stratified into three recurrence-risk groups. The prognoses were significantly different between each group, as the 3-year actual recurrence-free rates were 90% in low-risk group, 31% in intermediate-risk group, and 15% in high-risk group. Conclusion: We propose recurrence-risk stratification for postoperative HGM patients using clinically available factors. Our results suggest that the prognosis for patients with high-risk HGMs is dismal, whereas HGM patients belonging to the lowrisk group could have favorable prognoses. This stratification provides us with the criteria necessary to determine whether to apply adjuvant radiotherapy to postoperative HGM patients, and to also help identify potentially curable HGMs without adjuvant radiotherapy.

AB - Background: Radiotherapy for high-grade meningioma (HGM) is one of the essential treatment options for disease control. However, appropriate irradiation timing remains under debate. The object of this study is to discern which prognostic factors impact recurrence in HGM patients and to propose a risk-stratification system for the application of postoperative radiotherapy. Methods: We retrospectively reviewed 55 adult patients who were diagnosed with Grade II and III intracranial meningioma. Cox regression models were applied to the analysis for impact on early recurrence in HGM patients without postoperative radiotherapy. Results: Grade III malignancy (P = 0.0073) and transformed histology (P = 0.047) proved to be significantly poor prognostic factors of early recurrence by multivariate analysis. The other candidates for recurrence factors were Simpson Grade 3-5 resection, preoperative Karnofsky Performance status < = 70%, and MIB-1 labeling index > = 15%. According to these prognostic factors, postoperative HGM patients could be stratified into three recurrence-risk groups. The prognoses were significantly different between each group, as the 3-year actual recurrence-free rates were 90% in low-risk group, 31% in intermediate-risk group, and 15% in high-risk group. Conclusion: We propose recurrence-risk stratification for postoperative HGM patients using clinically available factors. Our results suggest that the prognosis for patients with high-risk HGMs is dismal, whereas HGM patients belonging to the lowrisk group could have favorable prognoses. This stratification provides us with the criteria necessary to determine whether to apply adjuvant radiotherapy to postoperative HGM patients, and to also help identify potentially curable HGMs without adjuvant radiotherapy.

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