Treatment outcomes of 17 patients with atypical spinal meningioma, including 4 with metastases: a retrospective observational study

Sung Hyun Noh, Kyung Hyun Kim, Dong Ah Shin, Jeong Yoon Park, Seong Yi, Sung Uk Kuh, Keung Nyun Kim, Dong Kyu Chin, Keun Su Kim, Do Heum Yoon, Yong Eun Cho

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Abstract

BACKGROUND CONTEXT: Because of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases. PURPOSE: The aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors. STUDY DESIGN: A retrospective chart review was performed. PATIENT SAMPLE: We retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma. OUTCOME MEASURES: We examined patients’ neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy. METHODS: The ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into two atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared. RESULTS: Seventeen patients were included in the analysis, of whom 12 (70%), 4 (24%), and 1 (6%) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88%) and 2 (12%) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (p<.001). Four patients (24%) had metastatic meningiomas in the brain, among whom three were administered adjuvant radiotherapy after surgery. Two patients with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4% and 85.2%, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (p<.05). CONCLUSIONS: Complete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered.

Original languageEnglish
Pages (from-to)276-284
Number of pages9
JournalSpine Journal
Volume19
Issue number2
DOIs
Publication statusPublished - 2019 Feb

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Meningioma
Observational Studies
Retrospective Studies
Neoplasm Metastasis
Disease-Free Survival
Neoplasms
Nervous System
Radiotherapy
Survival Rate
Sacrococcygeal Region
Spinal Cord Neoplasms
Adjuvant Radiotherapy
Disease Progression
Thorax
Regression Analysis
Magnetic Resonance Imaging
Demography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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Noh, Sung Hyun ; Kim, Kyung Hyun ; Shin, Dong Ah ; Park, Jeong Yoon ; Yi, Seong ; Kuh, Sung Uk ; Kim, Keung Nyun ; Chin, Dong Kyu ; Kim, Keun Su ; Yoon, Do Heum ; Cho, Yong Eun. / Treatment outcomes of 17 patients with atypical spinal meningioma, including 4 with metastases : a retrospective observational study. In: Spine Journal. 2019 ; Vol. 19, No. 2. pp. 276-284.
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abstract = "BACKGROUND CONTEXT: Because of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases. PURPOSE: The aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors. STUDY DESIGN: A retrospective chart review was performed. PATIENT SAMPLE: We retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma. OUTCOME MEASURES: We examined patients’ neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy. METHODS: The ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into two atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared. RESULTS: Seventeen patients were included in the analysis, of whom 12 (70{\%}), 4 (24{\%}), and 1 (6{\%}) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88{\%}) and 2 (12{\%}) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (p<.001). Four patients (24{\%}) had metastatic meningiomas in the brain, among whom three were administered adjuvant radiotherapy after surgery. Two patients with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4{\%} and 85.2{\%}, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (p<.05). CONCLUSIONS: Complete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered.",
author = "Noh, {Sung Hyun} and Kim, {Kyung Hyun} and Shin, {Dong Ah} and Park, {Jeong Yoon} and Seong Yi and Kuh, {Sung Uk} and Kim, {Keung Nyun} and Chin, {Dong Kyu} and Kim, {Keun Su} and Yoon, {Do Heum} and Cho, {Yong Eun}",
year = "2019",
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Noh, SH, Kim, KH, Shin, DA, Park, JY, Yi, S, Kuh, SU, Kim, KN, Chin, DK, Kim, KS, Yoon, DH & Cho, YE 2019, 'Treatment outcomes of 17 patients with atypical spinal meningioma, including 4 with metastases: a retrospective observational study', Spine Journal, vol. 19, no. 2, pp. 276-284. https://doi.org/10.1016/j.spinee.2018.06.006

Treatment outcomes of 17 patients with atypical spinal meningioma, including 4 with metastases : a retrospective observational study. / Noh, Sung Hyun; Kim, Kyung Hyun; Shin, Dong Ah; Park, Jeong Yoon; Yi, Seong; Kuh, Sung Uk; Kim, Keung Nyun; Chin, Dong Kyu; Kim, Keun Su; Yoon, Do Heum; Cho, Yong Eun.

In: Spine Journal, Vol. 19, No. 2, 02.2019, p. 276-284.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment outcomes of 17 patients with atypical spinal meningioma, including 4 with metastases

T2 - a retrospective observational study

AU - Noh, Sung Hyun

AU - Kim, Kyung Hyun

AU - Shin, Dong Ah

AU - Park, Jeong Yoon

AU - Yi, Seong

AU - Kuh, Sung Uk

AU - Kim, Keung Nyun

AU - Chin, Dong Kyu

AU - Kim, Keun Su

AU - Yoon, Do Heum

AU - Cho, Yong Eun

PY - 2019/2

Y1 - 2019/2

N2 - BACKGROUND CONTEXT: Because of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases. PURPOSE: The aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors. STUDY DESIGN: A retrospective chart review was performed. PATIENT SAMPLE: We retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma. OUTCOME MEASURES: We examined patients’ neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy. METHODS: The ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into two atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared. RESULTS: Seventeen patients were included in the analysis, of whom 12 (70%), 4 (24%), and 1 (6%) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88%) and 2 (12%) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (p<.001). Four patients (24%) had metastatic meningiomas in the brain, among whom three were administered adjuvant radiotherapy after surgery. Two patients with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4% and 85.2%, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (p<.05). CONCLUSIONS: Complete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered.

AB - BACKGROUND CONTEXT: Because of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases. PURPOSE: The aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors. STUDY DESIGN: A retrospective chart review was performed. PATIENT SAMPLE: We retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma. OUTCOME MEASURES: We examined patients’ neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy. METHODS: The ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into two atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared. RESULTS: Seventeen patients were included in the analysis, of whom 12 (70%), 4 (24%), and 1 (6%) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88%) and 2 (12%) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (p<.001). Four patients (24%) had metastatic meningiomas in the brain, among whom three were administered adjuvant radiotherapy after surgery. Two patients with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4% and 85.2%, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (p<.05). CONCLUSIONS: Complete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered.

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