Survival Benefit of Prognostic Factors and Treatment in Adult Patients with Recurrent Anaplastic Meningioma: A Retrospective Case Series and Systematic Literature Review

Abstract

Background: Recurrence rates of anaplastic meningioma (AM) are high even after a complete resection with postoperative radiotherapy. Objective: This study aimed to evaluate predictors and treatment affecting survival of recurrent AM based on our series and a systematic literature review (SLR). Methods: Our single-institute (SI) data enrolled patients with first recurrent AM, treated in our hospital from 2012 to 2018. We retrieved eligible cases from SLR from 1966 to 2020. Our SI data and pooled data, integrating SI and SLR data, were subject to Cox proportional hazard regression analysis. Results: Analysis from SI data (n = 38) showed that second recurrence-free survival (RFS) was associated with intervals (HR [hazard ratio], 0.263; P = 0.002), preoperative Karnofsky Performance Status (KPS) (HR, 0.450; P = 0.043), radiotherapy (HR, 0.395; P = 0.047), whereas overall survival (OS) was related to preoperative KPS (HR, 0.411; P = 0.037) and tumor size (HR, 3.429; P = 0.007). The pooled data (n = 60) indicated that short intervals (HR, 0.370; P = 0.002) and the use of radiotherapy (HR, 0.318; P = 0.003) improved second RFS and number of resections ≥3 (HR, 0.210; P = 0.002) and radiotherapy (HR, 0.209; P = 0.002) prolonged OS. Furthermore, the overall second RFS (P = 0.024) and OS (P = 0.031) stratified by 4 treatment protocols differed significantly. Conclusions: Early managements of patients with AM, before presence of poor preoperative KPS and large tumor size, are critical for survival. For patients with recurrent AM, survival benefits could be obtained from radiotherapy and multiple resections.