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Mitotic Index and Progression-Free Survival in Atypical Meningiomas.
World Neurosurg. 2020 Jun 29; 142:191-196.WN

Abstract

Extent of resection and tumor grade are considered the most important predictors of progression-free survival (PFS) in meningiomas. However, adjuvant therapy for atypical meningiomas remains controversial, with variable PFS rates of up to 40%. The current mitotic index (MI) range for atypical meningiomas is broad, comprising all tumors with >4 and <20 mitotic count per 10 high-power fields, leading to substantial within-grade variation of recurrence risk, especially in borderline histologic cases, creating discordance between the clinical course and the application of the classification criteria. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search of electronic databases from inception to July 2019 identified 121 articles for screening. After proper exclusion criteria, 7 articles were included for data extraction and analysis using meta-analysis of proportions. The MI was the variable of interest in the multivariate regressions and analyzed as a predictor of recurrence using hazard ratios (HRs) (95% confidence intervals). Separate random effect models were used for studies reporting the MI as a continuous or categorical variable. The pooled study results in this meta-analysis demonstrate a homogeneous statistically significant correlation between the MI and the rate of local recurrence after surgical resection regardless of the reporting method (continuous: HR = 1.20; categorical: HR = 2.65). However, significant limitations were noted, including the lack of a standardized method for MI calculation and heterogeneity of MI reports. We encourage the community to report their experience with the MI with greater precision and uniformity to further assess the influence of the MI on PFS within atypical meningiomas.

Authors+Show Affiliations

Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA.Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA.Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA.Neurologic Surgery Department, Mayo Clinic, Rochester, Minnesota, USA.Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA.Neurologic Surgery Department, Mayo Clinic, Jacksonville, Florida, USA. Electronic address: quinones@mayo.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32615290

Citation

Domingo, Ricardo A., et al. "Mitotic Index and Progression-Free Survival in Atypical Meningiomas." World Neurosurgery, vol. 142, 2020, pp. 191-196.
Domingo RA, Tripathi S, Vivas-Buitrago T, et al. Mitotic Index and Progression-Free Survival in Atypical Meningiomas. World Neurosurg. 2020;142:191-196.
Domingo, R. A., Tripathi, S., Vivas-Buitrago, T., Lu, V. M., Chaichana, K. L., & Quiñones-Hinojosa, A. (2020). Mitotic Index and Progression-Free Survival in Atypical Meningiomas. World Neurosurgery, 142, 191-196. https://doi.org/10.1016/j.wneu.2020.06.189
Domingo RA, et al. Mitotic Index and Progression-Free Survival in Atypical Meningiomas. World Neurosurg. 2020 Jun 29;142:191-196. PubMed PMID: 32615290.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mitotic Index and Progression-Free Survival in Atypical Meningiomas. AU - Domingo,Ricardo A, AU - Tripathi,Shashwat, AU - Vivas-Buitrago,Tito, AU - Lu,Victor M, AU - Chaichana,Kaisorn L, AU - Quiñones-Hinojosa,Alfredo, Y1 - 2020/06/29/ PY - 2020/05/30/received PY - 2020/06/22/accepted PY - 2020/7/3/pubmed PY - 2020/7/3/medline PY - 2020/7/3/entrez KW - Atypical meningioma KW - Gross total resection KW - Mitotic index KW - Progression-free survival KW - Recurrence KW - Subtotal resection KW - Surgical resection SP - 191 EP - 196 JF - World neurosurgery JO - World Neurosurg VL - 142 N2 - Extent of resection and tumor grade are considered the most important predictors of progression-free survival (PFS) in meningiomas. However, adjuvant therapy for atypical meningiomas remains controversial, with variable PFS rates of up to 40%. The current mitotic index (MI) range for atypical meningiomas is broad, comprising all tumors with >4 and <20 mitotic count per 10 high-power fields, leading to substantial within-grade variation of recurrence risk, especially in borderline histologic cases, creating discordance between the clinical course and the application of the classification criteria. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search of electronic databases from inception to July 2019 identified 121 articles for screening. After proper exclusion criteria, 7 articles were included for data extraction and analysis using meta-analysis of proportions. The MI was the variable of interest in the multivariate regressions and analyzed as a predictor of recurrence using hazard ratios (HRs) (95% confidence intervals). Separate random effect models were used for studies reporting the MI as a continuous or categorical variable. The pooled study results in this meta-analysis demonstrate a homogeneous statistically significant correlation between the MI and the rate of local recurrence after surgical resection regardless of the reporting method (continuous: HR = 1.20; categorical: HR = 2.65). However, significant limitations were noted, including the lack of a standardized method for MI calculation and heterogeneity of MI reports. We encourage the community to report their experience with the MI with greater precision and uniformity to further assess the influence of the MI on PFS within atypical meningiomas. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/32615290/Mitotic_Index_and_Progression_Free_Survival_in_Atypical_Meningiomas L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(20)31457-1 DB - PRIME DP - Unbound Medicine ER -
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