Progression-Free Survival and Factors Associated with Postoperative Recurrence in 126 Patients with Atypical Intracranial Meningioma

OBJECTIVE: Atypical meningioma has a higher recurrence rate than benign meningioma. The mainstay of treatment is surgery with or without radiation therapy (RT). The objective of this study was to investigate progression-free survival (PFS) and factors associated with postoperative recurrence in patients with atypical meningioma. METHODS: Patients with diagnoses of atypical menigioma who underwent surgery at Siriraj Hospital during the 2004 to 2014 study period were included. Features potentially associated with PFS and tumor recurrence from clinical records, operative records, and neuroimaging studies were evaluated and analyzed. RESULTS: One hundred twenty-six patients (mean age, 55 years) were included. The median PFS was 55 months. The 5-year and 10-year PFS rates were 72.5% and 32%, respectively. The median follow-up duration was 52 months. In multivariate analysis, tumor location (convexity, parasagittal/falcine, intraventricular, skull base) (P = 0.003), and pial invasion (hazard ratio [HR]: 2.02; P = 0.045) were significantly associated with tumor recurrence. Postoperative RT was associated with reduction in tumor recurrence in both univariate (odds ratio: 0.48; P = 0.039) and multivariate analysis (HR: 0.42; P = 0.005). CONCLUSIONS: Tumor location and pial invasion were significantly correlated with increased incidence of tumor recurrence, and postoperative RT was found to be significantly associated with decreased tumor progression and recurrence.