J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 13, Number 3, March 2021, pages 143-150

Pathologic Characteristics Associated With Local Recurrence of Atypical Meningiomas Following Surgical Resection

Figure 1. (a) Kaplan-Meier analysis of local failure of grade II meningiomas based on extent of surgical resection. (b) Kaplan-Meier sub-analysis of patients who suffered post-operative local failure (from Fig. 1a) to illustrate time to local failure difference between GTR and STR. Overall, progression was similar between the two cohorts (P = 0.18), but a sub-analysis after 12 months revealed a trend towards significance (P = 0.09). GTR: gross total resection, STR: subtotal resection.

Figure 2. Kaplan-Meier analysis of local failure of grade II meningiomas based on prior meningioma recurrence.

Figure 3. Kaplan-Meier analysis of the association of use of radiation therapy (RT) as a portion of post-recurrence patient salvage and time to second local failure.

**Table 1.** Patient Demographics and Features Predictive of Local Recurrence After Resection for Grade II Meningiomas
Variable	Recurrence	P value
STR: subtotal resection; GTR: gross total resection; IQR: interquartile range; RT: radiation therapy.
All patients	31 (63.3%)	18 (36.7%)
Age, median (± IQR)	50.5 ( ± 25)	50.0 ( ± 27)	0.615
Gender
Male (44.9%)	13 (59.1%)	9 (40.9%)	0.767
Female (55.1%)	18 (66.7%)	9 (33.3%)
Surgery
STR (29.6%)	8 (44.4%)	10 (55.6%)	0.064
GTR (64.8%)	23 (74.2%)	8 (25.8%)
Mitosis, median (IQR)	4 (0 - 10)	4 (0 - 10)	0.657
Necrosis
Absent (32.7%)	11 (68.8%)	5 (31.2%)	0.754
Present (67.3%)	20 (60.6%)	13 (39.4%)
Prominent nucleoli
Absent (59.2%)	20 (69.0%)	9 (31.0%)	0.375
Present (40.8%)	11 (55.0%)	9 (45.0%)
Architectural sheeting
Absent (65.3%)	22 (68.8%)	10 (31.3%)	0.226
Present (32.7%)	8 (50.0%)	8 (50.0%)
Hypercellularity
Absent (49.0%)	16 (66.7%)	8 (33.3%)	0.769
Present (51.0%)	15 (60.0%)	10 (40.0%)
Choroid or clear cell
Absent (93.9%)	26 (59.1%)	18 (40.9%)	0.276
Present (6.1%)	3 (100%)	0 (0.0%)
Ki-67, median (IQR)	8 (0 - 25)	10 (3 - 15)	0.763
Bone invasion
No (81.6%)	27 (67.5%)	13 (32.5%)	0.259
Yes (18.4%)	4 (44.4%)	5 (55.6%)
Brain invasion
No (77.6%)	24 (63.2%)	14 (36.8%)	1.000
Yes (22.4%)	7 (63.6%)	4 (36.4%)
Adjuvant RT
No (89.8%)	29 (65.9%)	15 (34.1%)	0.342
Yes (10.2%)	2 (40.0%)	3 (60.0%)
Prior recurrence
No (75.5%)	26 (70.3%)	11 (29.7%)	0.001
Yes (24.5%)	3 (25.0%)	9 (75.0%)

Table 1. Patient Demographics and Features Predictive of Local Recurrence After Resection for Grade II Meningiomas

Variable

Recurrence

P value

Yes

STR: subtotal resection; GTR: gross total resection; IQR: interquartile range; RT: radiation therapy.

All patients

31 (63.3%)

18 (36.7%)

Age, median (± IQR)

50.5 ( ± 25)

50.0 ( ± 27)

0.615

Gender

Male (44.9%)

13 (59.1%)

9 (40.9%)

0.767

Female (55.1%)

18 (66.7%)

9 (33.3%)

Surgery

STR (29.6%)

8 (44.4%)

10 (55.6%)

0.064

GTR (64.8%)

23 (74.2%)

8 (25.8%)

Mitosis, median (IQR)

4 (0 - 10)

0.657

Necrosis

Absent (32.7%)

11 (68.8%)

5 (31.2%)

0.754

Present (67.3%)

20 (60.6%)

13 (39.4%)

Prominent nucleoli

Absent (59.2%)

20 (69.0%)

9 (31.0%)

0.375

Present (40.8%)

11 (55.0%)

9 (45.0%)

Architectural sheeting

Absent (65.3%)

22 (68.8%)

10 (31.3%)

0.226

Present (32.7%)

8 (50.0%)

Hypercellularity

Absent (49.0%)

16 (66.7%)

8 (33.3%)

0.769

Present (51.0%)

15 (60.0%)

10 (40.0%)

Choroid or clear cell

Absent (93.9%)

26 (59.1%)

18 (40.9%)

0.276

Present (6.1%)

3 (100%)

0 (0.0%)

Ki-67, median (IQR)

8 (0 - 25)

10 (3 - 15)

0.763

Bone invasion

No (81.6%)

27 (67.5%)

13 (32.5%)

0.259

Yes (18.4%)

4 (44.4%)

5 (55.6%)

Brain invasion

No (77.6%)

24 (63.2%)

14 (36.8%)

1.000

Yes (22.4%)

7 (63.6%)

4 (36.4%)

Adjuvant RT

No (89.8%)

29 (65.9%)

15 (34.1%)

0.342

Yes (10.2%)

2 (40.0%)

3 (60.0%)

Prior recurrence

No (75.5%)

26 (70.3%)

11 (29.7%)

0.001

Yes (24.5%)

3 (25.0%)

9 (75.0%)

**Table 2.** Factors Associated With Time to Recurrence Following Resection in Grade II Meningiomas
Variable	Comparison group	Ref group	Hazard ratio	95% CI	P value
STR: subtotal resection; GTR: gross total resection; RT: radiation therapy; CI: confidence interval.
Univariable analysis
Gender	Male	Female	0.646	0.255	1.637	0.357
Age	Increasing age	0.997	0.968	1.026	0.823
Surgery	STR	GTR	3.278	1.261	8.526	0.015
RT	No	Yes	0.402	0.112	1.441	0.162
Necrosis	Present	Absent	1.195	0.425	3.357	0.736
Mitosis	Increasing mitotic count	0.945	0.740	1.207	0.765
Nucleoli	Present		1.127	0.445	2.855	0.801
Architectural sheeting	Absent	Present	0.568	0.224	1.444	0.235
Hypercellularity	Absent	Present	1.102	0.426	2.854	0.841
Choroid	Absent	Present	4.889	0.151	157.8	0.371
Bone invasion	Absent	Present	0.531	0.189	1.493	0.230
Brain invasion	Absent	Present	0.839	0.275	2.558	0.758
Ki-67	Increasing Ki-67	0.985	0.858	1.130	0.826
Prior recurrence	No prior	Prior	0.231	0.091	0.588	0.002
Multivariable analysis
Surgery	STR	GTR	0.452	0.163	1.253	0.127
Prior recurrence	No prior	Prior	0.268	1.201	8.897	0.021

Table 2. Factors Associated With Time to Recurrence Following Resection in Grade II Meningiomas

Variable

Comparison group

Ref group

Hazard ratio

95% CI

P value

STR: subtotal resection; GTR: gross total resection; RT: radiation therapy; CI: confidence interval.

Univariable analysis

Gender

Male

Female

0.646

0.255

1.637

0.357

Age

Increasing age

0.997

0.968

1.026

0.823

Surgery

STR

GTR

3.278

1.261

8.526

0.015

Yes

0.402

0.112

1.441

0.162

Necrosis

Present

Absent

1.195

0.425

3.357

0.736

Mitosis

Increasing mitotic count

0.945

0.740

1.207

0.765

Nucleoli

Present

1.127

0.445

2.855

0.801

Architectural sheeting

Absent

Present

0.568

0.224

1.444

0.235

Hypercellularity

Absent

Present

1.102

0.426

2.854

0.841

Choroid

Absent

Present

4.889

0.151

157.8

0.371

Bone invasion

Absent

Present

0.531

0.189

1.493

0.230

Brain invasion

Absent

Present

0.839

0.275

2.558

0.758

Ki-67

Increasing Ki-67

0.985

0.858

1.130

0.826

Prior recurrence

No prior

Prior

0.231

0.091

0.588

0.002

Multivariable analysis

Surgery

STR

GTR

0.452

0.163

1.253

0.127

Prior recurrence

No prior

Prior

0.268

1.201

8.897

0.021

**Table 3.** Factors Associated With Time to Second Recurrence in Grade II Meningiomas
Variable	Comparison group	Reference group	Hazard ratio	95% CI	P value
STR: subtotal resection; GTR: gross total resection; RT: radiation therapy; CI: confidence interval.
Univariable analysis
Gender	Male	Female	0.274	0.067	1.132	0.074
Age	Increasing age	0.985	0.947	1.025	0.466
Surgery	STR	GTR	3.248	0.676	15.608	0.141
RT after initial resection	No	Yes	0.099	0.016	0.608	0.013
Necrosis	Present	Absent	1.416	0.360	5.567	0.619
Mitosis	Increasing mitotic count	1.068	0.807	1.413	0.646
Nucleoli	Present		0.985	0.288	3.371	0.981
Architectural sheet	Absent	Present	0.208	0.040	1.069	0.060
Hypercellularity	Absent	Present	0.647	0.168	2.4	0.526
Bone invasion	Absent	Present	0.052	0.006	0.456	0.008
Brain invasion	Absent	Present	0.890	0.179	4.427	0.887
Ki-67	Increasing Ki-67	1.165	0.826	1.643	0.385
Prior recurrence	No	Yes	0.507	0.145	1.782	0.289
Received salvage RT	Yes	No	0.020	0.001	0.189	0.019
Received salvage resection	Yes	No	1.959	0.595	7.146	0.296
Prior recurrence	No prior	Prior	0.507	0.145	1.782	0.290
Multivariable analysis
Bone invasion	Absent	Present	0.550	0.050	10.508	0.659
RT after initial resection	No	Yes	3.971	0.524	43.611	0.255
Received salvage RT	Yes	No	0.011	0.001	0.316	0.037

Table 3. Factors Associated With Time to Second Recurrence in Grade II Meningiomas

Variable

Comparison group

Reference group

Hazard ratio

95% CI

P value

STR: subtotal resection; GTR: gross total resection; RT: radiation therapy; CI: confidence interval.

Univariable analysis

Gender

Male

Female

0.274

0.067

1.132

0.074

Age

Increasing age

0.985

0.947

1.025

0.466

Surgery

STR

GTR

3.248

0.676

15.608

0.141

RT after initial resection

Yes

0.099

0.016

0.608

0.013

Necrosis

Present

Absent

1.416

0.360

5.567

0.619

Mitosis

Increasing mitotic count

1.068

0.807

1.413

0.646

Nucleoli

Present

0.985

0.288

3.371

0.981

Architectural sheet

Absent

Present

0.208

0.040

1.069

0.060

Hypercellularity

Absent

Present

0.647

0.168

2.4

0.526

Bone invasion

Absent

Present

0.052

0.006

0.456

0.008

Brain invasion

Absent

Present

0.890

0.179

4.427

0.887

Ki-67

Increasing Ki-67

1.165

0.826

1.643

0.385

Prior recurrence

Yes

0.507

0.145

1.782

0.289

Received salvage RT

Yes

0.020

0.001

0.189

0.019

Received salvage resection

Yes

1.959

0.595

7.146

0.296

Prior recurrence

No prior

Prior

0.507

0.145

1.782

0.290

Multivariable analysis

Bone invasion

Absent

Present

0.550

0.050

10.508

0.659

RT after initial resection

Yes

3.971

0.524

43.611

0.255

Received salvage RT

Yes

0.011

0.001

0.316

0.037