• Kira Tosefsky, Alexander D Rebchuk, Justin Z Wang, Yosef Ellenbogen, Richard Drexler, Franz L Ricklefs, Thomas Sauvigny, Ulrich Schüller, Christopher B Cutler, Brandon Lucke-Wold, Yusuf Mehkri, Sanju Lama, Garnette R Sutherland, Michael Karsy, Brian L Hoh, Manfred Westphal, Gelareh Zadeh, Stephen Yip, and Serge Makarenko.
• 1MD Undergraduate Program, University of British Columbia.
• J. Neurosurg. 2024 Feb 1; 140 (2): 393403393-403.

ObjectiveGrade 3 meningioma represents a rare meningioma subtype, for which limited natural history data are available. The objective of this study was to identify demographics and pathologic characteristics, clinical and functional status outcomes, and prognostic factors in an international cohort of grade 3 meningioma patients.MethodsClinical and histopathological data were collected for patients treated at 7 sites across North America and Europe between 1991 and 2022.ResultsA total of 103 patients (54% female, median age 65 [IQR 52, 72] years) were included. Sixty-seven (65%) patients had de novo grade 3 lesions, whereas 29 (28%) had malignant transformations of lower-grade meningiomas. All patients underwent initial resection of their tumor. Patients were followed for a median of 46 (IQR 24, 108) months, during which time there were 65 (73%) recurrences and 50 (49%) deaths. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66% (95% CI 56%-77%) and 37% (95% CI 28%-48%), respectively. Age ≥ 65 years and male sex were independent predictors of worse OS and PFS in multivariate regression analysis, while postoperative radiotherapy was independently associated with improved OS. Karnofsky Performance Status (KPS) remained stable relative to baseline over 5 years postdiagnosis among participants who were alive at the end of the follow-up period.ConclusionsThis large multicenter study provides insight into the longitudinal outcomes of grade 3 meningioma, with respect to recurrence, survival, and functional status. This study affirms the survival benefit conferred by radiotherapy in this population and suggests good functional status outcomes for patients surviving to 5 years postoperatively.

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