Clinical Features And Risk Factors Associated With Postoperative Recurrence In Atypical Meningioma:analysis Of 263 Cases

ObjectivesAtypical meningioma(AM)has a high rate of local recurrence after surgery,and the role of adjuvant radiotherapy in AM remains controversial.We analysed clinical features and identified the factors associated with postoperative recurrence in AM patients.Patients and MethodsData were obtained from 263 AM patients who underwent surgery at our institution between October 2009 and September 2018.Analyses included factors such as the extent of surgical resection,Molecular Immunology Borstel-1 index(MIB-1),brain invasion and therapy modality.Univariate and multivariate analyses were used to assess recurrence-related prognostic factors.ResultsThe median follow-up duration was 41 months,and the median PFS was 28months.Gross total resection(GTR)was achieved in 213(81.0%)patients,and 86(32.7%)patients received postoperative radiation therapy(RT).During follow-up,there were 61(23.2%)tumour recurrences.In a Coxmultivariate analysis,MIB-1 labelling index(hazard ratio=2.637;p<0.001),secondary tumour(hazard ratio=3.541;p<0.001),tumour size(hazard ratio=1.818;p=0.032)and extent of resection(hazard ratio=2.861;p<0.001)were independent significant predictors of tumour recurrence.RT was associated with reduced tumour recurrence in subtotal resection(STR)(p=0.023)but not GTR(p=0.923).An analysis of 6 meningioma patients who underwent more than 3 operations suggested that the recurrence time became shorter and the MIB-1 labelling index increased as the number of recurrences increased.ConclusionsMIB-1 labelling index,secondary tumour,tumour size and extent of resection were powerful predictors of recurrence in AM patients.Postoperative RT did not decrease the risk of recurrence in GTR patients.