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Regrowth factors of WHO grade I skull base meningiomas following incomplete resection

 Hun Ho Park  ;  Jihwan Yoo  ;  Hyeong-Cheol Oh  ;  Yoon Jin Cha  ;  Se Hoon Kim  ;  Chang-Ki Hong  ;  Kyu-Sung Lee 
 JOURNAL OF NEUROSURGERY, Vol.137(6) : 1656-1665, 2022-12 
Journal Title
Issue Date
Humans ; Ki-67 Antigen ; Meningeal Neoplasms* / diagnosis ; Meningeal Neoplasms* / radiotherapy ; Meningeal Neoplasms* / surgery ; Meningioma* / diagnosis ; Meningioma* / radiotherapy ; Meningioma* / surgery ; Neoplasm Recurrence, Local / surgery ; Neurosurgical Procedures ; Retrospective Studies ; Skull Base / surgery ; Treatment Outcome ; World Health Organization
WHO grade I ; incomplete resection ; natural behavior ; oncology ; regrowth ; residual tumor ; skull base meningioma
Objective: The role of adjuvant radiation therapy following incomplete resection of WHO grade I skull base meningiomas (SBMs) is controversial, and little is known regarding the behavior of residual tumors. The authors investigated the factors that influence regrowth of residual WHO grade I SBMs following incomplete resection.

Methods: From 2005 to 2019, a total of 710 patients underwent surgery for newly diagnosed WHO grade I SBMs. The data of 115 patients (16.2%) with incomplete resection and without any adjuvant radiotherapy were retrospectively assessed during a mean follow-up of 78 months (range 27-198 months). Pre-, intra-, and postoperative clinical and molecular factors were analyzed for relevance to regrowth-free survival (RFS).

Results: Eighty patients were eligible for analysis, excluding those who were lost to follow-up (n = 10) or had adjuvant radiotherapy (n = 25). Regrowth occurred in 39 patients (48.7%), with a mean RFS of 50 months (range 3-191 months). Significant predictors of regrowth were Ki-67 proliferative index (PI) ≥ 4% (p = 0.017), Simpson resection grades IV and V (p = 0.005), and invasion of the cavernous sinus (p = 0.027) and Meckel's cave (p = 0.027). After Cox regression analysis, only Ki-67 PI ≥ 4% (hazard ratio [HR] 9.39, p = 0.003) and Simpson grades IV and V (HR 8.65, p = 0.001) showed significant deterioration of RFS. When stratified into 4 scoring groups, the mean RFSs were 110, 70, 38, and 9 months for scores 1 (Ki-67 PI < 4% and Simpson grade III), 2 (Ki-67 PI < 4% and Simpson grades IV and V), 3 (Ki-67 PI ≥ 4% and Simpson grade III), and 4 (Ki-67 PI ≥ 4% and Simpson grades IV and V), respectively. RFS was significantly longer for score 1 versus scores 2-4 (p < 0.01). Tumor consistency, histology, location, peritumoral edema, vascular encasement, and telomerase reverse transcriptase promoter mutation had no impact on regrowth.

Conclusions: Ki-67 PI and Simpson resection grade showed significant associations with RFS for WHO grade I SBMs following incomplete resection. Ki-67 PI and Simpson resection grade could be utilized to stratify the level of risk for regrowth.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
Yoo, Jihwan(유지환)
Lee, Kyu Sung(이규성)
Cha, Yoon Jin(차윤진) ORCID logo https://orcid.org/0000-0002-5967-4064
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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