Predictors of early recurrence in meningioma

Abstract

Purpose – Although meningiomas have mostly a favourable prognosis, some have early recurrences or the need for a new treatment, irrespective of the histological grade. In this study, we aimed to characterize clinical, radiological, and molecular markers in a cohort of patients with early recurrent meningiomas. Methods – We conducted a retrospective, non-interventional study of patients with World Health Organization (WHO) grade 1 or 2 meningiomas who underwent surgical resection at Centro Hospitalar Universitário de São João between 2010 and 2021, and who had tumour recurrence or needed retreatment in the subsequent 5 years. We analysed demographic, clinical, radiological, histological, treatment-associated parameters, molecular features (TERT promotor mutations and CDKN2A/B deletion), and progression/survival data. An analysis was conducted to determine which variables were associated with shorter time-to-progression, aiming to identify predictors with a greater impact on early and rapid recurrence. Results – We evaluated 64 patients. The median time of progression-free survival (PFS) was 26 months. Shorter PFS was associated with WHO grade 2 (11 vs 27 months, p = 0.010), mitotic index ≥8 (7 vs 26 months, p <0.001), and T1-weighted image signal (T1w) hyperintensity (15 vs 26 months, p = 0.025). None of the cases showed CDKN2A/B deletion, while TERT promoter mutations were detected in four meningiomas. Conclusion – In this study of early recurrence of meningiomas, WHO grade 2, mitotic index ≥8, and T1w hyperintensity were significantly associated with shorter PFS, while molecular biomarkers usually associated with shorter PFS (TERT promoter mutations and CDKN2A/B deletion) were only detected in four patients.