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. 2012 May;14(5):658-66.
doi: 10.1093/neuonc/nos013. Epub 2012 Mar 9.

Impaired survival and long-term neurological problems in benign meningioma

Hanna van Alkemade  1 , Michelle de Leau, Edith M T Dieleman, Jan W P F Kardaun, Rob van Os, W Peter Vandertop, Wouter R van Furth, Lukas J A Stalpers
Affiliations

Impaired survival and long-term neurological problems in benign meningioma

Hanna van Alkemade et al. Neuro Oncol. 2012 May.

Abstract

Purpose: To assess long-term functional outcome and survival among patients with meningioma World Health Organization (WHO) grade I.

Methods: Retrospective analysis of 205 patients after resection of WHO grade I intracranial meningioma from 1985 through 2003. Expected age- and sex-specific survival was calculated by applying Dutch life-table statistics to each patient for the individual duration of follow-up. Long-term functional outcome was assessed using a mailed questionnaire to the general practitioner.

Results: The mean duration of follow-up was 11.5 years. Survival at 5, 10, 15, and 20 years was 92%, 81%, 63%, and 53%, respectively, which is significantly lower than the expected survival (94%, 86%, 78%, and 66%, respectively). Survival was worse with higher age (P < .001). Survival among patients younger than 45 years and older than 65 years was comparable to the expected survival but significantly worse among patients aged 45-65 years. Analysis of the cause of death suggests an excess mortality associated with both brain tumor death and stroke (P = .07). Recurrence rates at 5, 10, and 15 years were 18%, 26%, and 32%, respectively. Higher Simpson grade (P < .001) and lower age (P = .02) were associated with a higher recurrence rate. In 29 patients (14%) receiving radiotherapy, the 5-year recurrence rate was 18% and the 5-year survival was only 58%. Long-term functioning (≥ 5 years after last treatment) could be assessed in 89 long-term survivors: 29 patients (33%) showed no deficits, and 60 (67%) showed at least 1 neurological symptom, of whom 24 (27%) were unable to perform normal daily activities.

Conclusion: Long-term survival in WHO grade I meningioma is challenged in patients more than 45 years of age. Excess mortality seems to be associated with both tumor recurrence and stroke. The majority of patients have long-term neurological problems.

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Figures

Fig. 1.
Fig. 1.
Observed and expected age- and sex-specific survival. The bars indicate the 95% confidence intervals (CIs) at 5, 10, 15, and 20 years. Despite increasing CIs, after 13 years, the observed survival lies significantly below the expected survival curve.
Fig. 2.
Fig. 2.
Univariable curves for survival by age group. Dotted lines give the age- and sex-specific survival.
See this image and copyright information in PMC

References

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