Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 9;83(Suppl 2):e530-e536.
doi: 10.1055/s-0041-1733974. eCollection 2022 Jun.

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

Colin J Przybylowski  1 , Benjamin K Hendricks  1 , Charuta G Furey  1 , Joseph D DiDomenico  1 , Randall W Porter  1 , Nader Sanai  1 , Kaith K Almefty  1 , Andrew S Little  1
Affiliations

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

Colin J Przybylowski et al. J Neurol Surg B Skull Base. .

Abstract

Objective This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas. Study Design This study is a retrospective volumetric analysis. Setting This study was conducted at a single institution. Participants Patients who underwent subtotal resection of a WHO grade I skull base meningioma and postsurgical observation (July 1, 2007-July 1, 2017). Main Outcome Measure The main outcome was radiographic tumor progression. Results Sixty patients with residual skull base meningiomas were analyzed. The median (interquartile range) RTV was 1.3 (5.3) cm 3 . Tumor progression occurred in 23 patients (38.3%) at a mean duration of 28.6 months postsurgery. The 1-, 3-, and 5-year actuarial progression-free survival (PFS) rates were 98.3, 58.6, and 48.7%, respectively. The Cox multivariate analysis identified increasing RTV ( p = 0.01) and history of more than 1 previous surgery ( p = 0.03) as independent predictors of tumor progression. In a Kaplan-Meier analysis for PFS, the RTV threshold of 3 cm 3 maximized log-rank testing significance between groups of patients dichotomized at 0.5 cm 3 thresholds ( p < 0.01). The 3-year actuarial PFS rates for meningiomas with RTV ≤3 cm 3 and >3 cm 3 were 76.2 and 32.1%, respectively. When RTV >3 cm 3 was entered as a covariate in the Cox model, it was the only factor independently associated with tumor progression ( p < 0.01). Conclusion RTV was associated with tumor progression after subtotal resection of WHO grade I skull base meningioma in this cohort. An RTV threshold of 3 cm 3 was identified that minimized progression of the residual tumor when gross total resection was not safe or feasible.

Keywords: meningioma; progression; recurrence; residual; skull base; tumor.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest A.S.L. is a consultant for SPIWay, LLC, and has an ownership interest in Kogent Surgical, LLC. The other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier progression-free survival curve of the entire cohort. Reproduced with permission from Barrow Neurological Institute, Phoenix, Arizona.
Fig. 2
Fig. 2
Kaplan–Meier progression free survival curves comparing patients with RTV ≤3 cm 3 to patients with RTV >3 cm 3 . RTV, residual tumor volume. Reproduced with permission from Barrow Neurological Institute, Phoenix, Arizona.
Fig. 3
Fig. 3
Dot plot of RTV versus PFS. RTV (left-side y-axis) and PFS (right-side y-axis) were plotted for all 60 patients. Each vertical bar represents an individual patient's RTV. The PFS for each patient is plotted as a dot aligned with the patient's RTV. The PFS data dichotomized at the RTV threshold of 3 cm 3 (dashed vertical line). PFS, progression-free survival; RTV, residual tumor volume. Reproduced with permission from Barrow Neurological Institute, Phoenix, Arizona.
See this image and copyright information in PMC

References

    1. Przybylowski C J, Hendricks B K, Frisoli F A et al. Prognostic value of the Simpson grading scale in modern meningioma surgery: Barrow Neurological Institute experience. J Neurosurg. 2020:1–9. - PubMed
    1. Nanda A, Bir S C, Maiti T K, Konar S K, Missios S, Guthikonda B. Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization grade I meningioma. J Neurosurg. 2017;126(01):201–211. - PubMed
    1. Winther T L, Torp S H. Significance of the extent of resection in modern neurosurgical practice of World Health Organization grade I meningiomas. World Neurosurg. 2017;99:104–110. - PubMed
    1. Materi J, Mampre D, Ehresman J, Rincon-Torroella J, Chaichana K L. Predictors of recurrence and high growth rate of residual meningiomas after subtotal resection. J Neurosurg. 2020:1–7. - PubMed
    1. Youngblood M W, Duran D, Montejo J D et al. Correlations between genomic subgroup and clinical features in a cohort of more than 3000 meningiomas. J Neurosurg. 2019:1–10. - PubMed