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. 2023 Aug 1;93(2):339-347.
doi: 10.1227/neu.0000000000002416. Epub 2023 Feb 23.

Conditional Recurrence-Free Survival After Surgical Resection of Meningioma

Alan R Tang  1 , Silky Chotai  2 , Bradley S Guidry  1 , Lili Sun  3 , Fei Ye  3 , Patrick D Kelly  2 , Jake R McDermott  4 , Candace J Grisham  1 , Peter J Morone  2 , Reid C Thompson  2 , Lola B Chambless  2
Affiliations

Conditional Recurrence-Free Survival After Surgical Resection of Meningioma

Alan R Tang et al. Neurosurgery. .

Abstract

Background: Recurrence after meningioma resection warrants serial surveillance imaging, but little evidence guides the optimal time interval between imaging studies/surveillance duration.

Objective: To describe recurrence-free survival (RFS) after meningioma resection, conditioned to short-term RFS.

Methods: A retrospective cohort study for adults presenting for meningioma resection from 2000 to 2018 was conducted. The primary outcome was postoperative follow-up RFS. Conditional RFS Kaplan-Meier analysis was performed at 1, 2, 3, 5, and 10 years, conditioned to 6-month and 12-month RFS. RFS probabilities conditioned to 6-month RFS were estimated in subgroups, stratified by World Health Organization grade, extent of resection, and need for postoperative radiation.

Results: In total, 723 patients were included. Median age at surgery was 57.4 years (IQR = 47.2-67.2). Median follow-up was 23.5 months (IQR = 12.3-47.8). Recurrence was observed in 90 patients (12%), with median time to recurrence of 14.4 months (IQR = 10.3-37.1). Conditioned to 6-month postoperative RFS, patients had 90.3% probability of remaining recurrence-free at 2 years and 69.4% at 10 years. Subgroup analysis conditioned to 6-month RFS demonstrated grade 1 meningiomas undergoing gross total resection (GTR) had 96.0% probability of RFS at 1 year and 82.8% at 5 years, whereas those undergoing non-GTR had 94.5% and 79.9% probability, respectively. RFS probability was 78.8% at 5 years for non-grade 1 meningiomas undergoing GTR, compared with 69.7% for non-grade 1 meningiomas undergoing non-GTR. Patients with non-grade 1 meningiomas undergoing upfront radiation had a 1-year RFS of 90.1% and 5-year RFS of 51.7%.

Conclusion: Recurrence risk after meningioma resection after an initial recurrence-free period is reported, with high-risk subgroups identified. These results can inform objective shared decision-making for optimal follow-up.

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