‘Meningiomics’—an integration of data on the patient, tumour, extent of resection and molecular pathology to optimise the management and follow-up for meningiomas

Excerpt

Champeaux and colleagues report on the outcomes from a single-institution study of 505 patients with WHO grade I cranial meningiomas who underwent treatment between 2003 and 2017. During the median follow-up period of 6.2 years (IQR, 2.8–9.5), 74 patients had meningioma recurrence or a meningioma-related death, whilst 84 patients died from other causes. The median age at death was 71.7 years (IQR, 59.6–78.6), and eight patients died within 1 month of surgery, and 29 within a year. Twenty-five patients had early recurrence requiring re-operating at a median 1.3 years (IQR, 0.2–2.6) after the first surgery. Eleven patients had progression to grade II or III meningioma. The authors performed a competing risk analysis, which takes into consideration that when death occurs due to other causes (e.g. myocardial infarction), it prevents the observation of the events of interest—namely meningioma recurrence or meningioma-related death. Based on analysis of their data, the absolute risk of WHO grade I meningioma recurrence or death is 16.2% at 5 years and 24.4% at 10 years. As expected, the factors for meningioma-related death or progression were venous sinus invasion, subtotal resection (defined as Simpson grade 4 or 5), and growth of residual tumour. The authors comment that this data can be used to rationalise follow-up and propose that when gross total resection (Simpson grades 1–3) is achieved, imaging surveillance for 3 years for convexity meningioma and 6 years for all other locations is required. When a subtotal resection is performed, then 8 years of imaging follow-up is sufficient if there is no evidence of meningioma progression. …