Laboratory of Molecular and Cellular Biology (LIM15), Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Avenida Dr Arnaldo, 455/ 4º andar/ sala 4110, São Paulo, SP, 01246-903, Brazil.
Neurosurgery Division, Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil.
Neurosurg Rev. 2024 Sep 28;47(1):704. doi: 10.1007/s10143-024-02881-4.
Meningiomas and their WHO histological diagnostic criteria is complex, especially for grade 2 tumors presenting a interobserver discordance as high as 12.2%. The 2016 edition of the WHO Classification of CNS tumors recommended brain invasion as a stand-alone grading criterion for diagnosing an atypical grade 2 meningioma (AM). To provide an overview of the classification of 2016 WHO impact on the natural history of atypical meningioma (AM) relative to previous classification. To achieve this goal, we selected articles from the period 2017-2024 in Medline search on atypical meningiomas and analyzed them after following the following criteria: 1) reports with confirmed histopathological diagnosis according to WHO 2016 and or 2021 criteria; 2) series and case reports; 3) detailed and individualized clinical outcomes for AM; and 4) papers written in English; after that a total of 3445 patients reported in 67 manuscripts from worldwide centers from 2017 to March 2024 were analyzed. The patient's age at the time of surgery ranged from 1 month to 97 years (mean 52.28 ± 18.7 years). The most common tumor site was the convexity, accounting for 67.8%, followed by the skull base in 30.6%, ventricle in 1%, and spine in 0.6%; Gross total resection (GTR) was performed in 71.25% and subtotal resection (STR) in 28.75%; 1021 patients (29.63%) underwent adjuvant radiotherapy, and 22 patients (0.6%) were treated with adjuvant chemotherapy; tumor recurrence was reported in 1221 patients (35.44%) and 859 deaths (24.93%). 1) AM prevalence in females; 2) AM age distribution similar to the distribution of meningiomas in general; 3) AM recurrence rate of 35.44%, despite the high rate of GTR, which was higher than previously reported; 4) deepening knowledge in molecular mechanism of tumor progression will provide alternative therapeutic approaches for AM.
脑膜瘤及其世界卫生组织（WHO）组织学诊断标准较为复杂，尤其是 2 级肿瘤，观察者间的不一致性高达 12.2%。2016 年版《WHO 中枢神经系统肿瘤分类》建议将脑侵犯作为诊断非典型性 2 级脑膜瘤（AM）的独立分级标准。本文旨在概述 2016 年版 WHO 分类对 AM 自然史的影响，以及与以往分类的比较。为了实现这一目标，我们在 Medline 中检索了 2017 年至 2024 年期间的关于非典型脑膜瘤的文章，并根据以下标准进行了分析：1）根据 2016 年和/或 2021 年 WHO 标准确认的组织病理学诊断报告；2）系列和病例报告；3）详细的、个体化的 AM 临床结局；4）英文书写的论文。最终，共分析了来自全球中心的 67 篇文献中的 3445 例患者，这些文献发表于 2017 年至 2024 年 3 月期间。患者手术时的年龄范围为 1 个月至 97 岁（平均 52.28±18.7 岁）。最常见的肿瘤部位是凸面，占 67.8%，其次是颅底占 30.6%，脑室占 1%，脊柱占 0.6%；肿瘤全切除（GTR）率为 71.25%，次全切除（STR）率为 28.75%；1021 例患者（29.63%）接受了辅助放疗，22 例患者（0.6%）接受了辅助化疗；1221 例患者（35.44%）报告肿瘤复发，859 例患者（24.93%）死亡。1）AM 在女性中的患病率；2）AM 的年龄分布与脑膜瘤的总体分布相似；3）尽管 GTR 率较高，但 AM 的复发率为 35.44%，高于以往报道；4）深入了解肿瘤进展的分子机制将为 AM 提供替代治疗方法。
