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. 2021 Mar;152(1):145-151.
doi: 10.1007/s11060-020-03688-1. Epub 2021 Jan 9.

Resected WHO grade I meningioma and predictors of local control

Kamila Nowak-Choi #  1 , Joshua D Palmer #  2 , James Casey  3 , Ameet Chitale  3 , Ingrid Kalchman  4 , Elizabeth Buss  4 , Scott W Keith  5 , Sarah E Hegarty  5 , Mark Curtis  6 , Charalambos Solomides  6 , Wenyin Shi  7 , Kevin Judy  3 , David W Andrews  3 , Christopher Farrell  3 , Maria Werner-Wasik  7
Affiliations

Resected WHO grade I meningioma and predictors of local control

Kamila Nowak-Choi et al. J Neurooncol. 2021 Mar.

Abstract

Introduction: Despite optimal surgical resection, meningiomas may recur, with increasing grade and the degree of resection being predictive of risk. We hypothesize that an increasing Ki67 correlates with a higher risk of recurrence of resected WHO grade I meningiomas.

Methods: The study population consisted of patients with resected WHO grade 1 meningiomas in locations outside of the base of skull. Digitally scanned slides stained for Ki67 were analyzed using automatic image analysis software in a standardized fashion.

Results: Recurrence was observed in 53 (17.7%) of cases with a median follow up time of 25.8 months. Ki67 ranged from 0 to 30%. Median Ki67 was 5.1% for patients with recurrence and 3.5% for patients without recurrence. In unadjusted analyses, high Ki-67 (≥ 5 vs. < 5) vs. ≥ 5) was associated with over a twofold increased risk of recurrence (13.1% vs. 27% respectively; HR 2.1731; 95% CI [1.2534, 3.764]; p = 0.006). After Adjusting for patient or tumor characteristics, elevated Ki-67 remained significantly correlated with recurrence. Grade 4 Simpson resection was noted in 71 (23.7%) of patients and it was associated with a significantly increased risk of recurrence (HR 2.56; 95% CI [1.41, 4.6364]; p = 0.002).

Conclusions: WHO grade 1 meningiomas exhibit a significant rate of recurrence following resection. While Ki-67 is not part of the WHO grading criteria of meningiomas, a value greater than 5% is an independent predictor for increased risk of local recurrence following surgical resection.

Keywords: Extent of resection; Ki-67; Radiation treatment; Recurrence risk; WHO grade I meningioma.

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