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Prognostic significance of brain invasion in meningiomas: systematic review and meta-analysis

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Abstract

The WHO 2016 classification introduced brain invasion as a standalone criterion for grade II meningioma (GIIM). We systematically reviewed studies published after 2000 and performed a PRISMA-compliant meta-analysis of the hazard ratios (HRs) for progression-free survival (PFS) between brain-invasive and noninvasive meningiomas. In five studies that included both benign and higher-grade meningiomas, brain invasion was a significant risk factor for recurrence (HR = 2.45, p = 0.0004). However, in 3 studies comparing “brain-invasive meningioma with otherwise benign histology (BIOB)” with grade I meningioma, brain invasion was not a significant predictor of PFS (HR = 1.49, p = 0.23). Among GIIM per the WHO 2000 criteria, brain invasion was a significant predictor of shorter PFS than noninvasive GIIM (HR = 3.40, p = 0.001) but not per the WHO 2016 criteria (HR 1.13, p = 0.54), as the latter includes BIOB. Meta-regression analysis of seven studies of grade II meningioma showed that more frequent BIOB was associated with lower HRs (p < 0.0001). Hence, there is no rationale for brain invasion as a standalone criterion for grade II meningioma, although almost all studies were retrospective and exhibited highly heterogeneous HRs due to differences in brain–tumor interface data availability.

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Acknowledgments

We are grateful to Prof. Jože Pižem (Institute of Pathology, University of Ljubljana), Dr. Fang Wang, and Prof. Fuyou Guo (Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University), and Dr. Luca Bertero (Pathology Unit, University of Turin) for their kind cooperation.

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Authors and Affiliations

  1. Division of Neurosurgery, Kusatsu General Hospital, Yabase-cho 1660, Kusatsu, Shiga, 525-8585, Japan

    Satoshi Nakasu

  2. Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan

    Satoshi Nakasu & Yoko Nakasu

  3. Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Japan

    Yoko Nakasu

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  1. Satoshi Nakasu
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  2. Yoko Nakasu
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Correspondence to Satoshi Nakasu.

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Nakasu, S., Nakasu, Y. Prognostic significance of brain invasion in meningiomas: systematic review and meta-analysis. Brain Tumor Pathol 38, 81–95 (2021). https://doi.org/10.1007/s10014-020-00390-y

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