Male sex and presence of preoperative symptoms are associated with early recurrence of WHO grade I meningiomas after surgical resection: analysis from the nationwide Brain Tumor Registry of Japan

This study aimed to assess the risk factors for the recurrence of WHO grade I intracranial meningiomas using the Brain Tumor Registry of Japan (BTRJ) database. We extracted the data of 4641 patients with intracranial WHO grade I meningiomas treated only by surgical resection between 2001 and 2008. We conducted complete data analysis ( n = 3690) and multiple imputation analysis ( n = 4641) to adjust for missing data on tumor size. The influence of factors including age, sex, size, extent of resection, location, and preoperative symptoms on PFS was assessed. Univariate analyses of the complete data set showed that age did not affect PFS; however, male sex ( p < 0.001), tumor size ≥ 30 mm ( p < 0.001), low extent of resection, tumor location at the skull base ( p < 0.001), and the presence of preoperative symptoms ( p < 0.001) were risk factors for a significantly shorter PFS. Multivariate analysis demonstrated that male sex ( p < 0.001) and presence of preoperative symptoms ( p = 0.027) were independent risk factors for shorter PFS alongside large tumor size ( p < 0.001) and non-gross total resection ( p < 0.001). These results were confirmed for the imputed dataset. While most previous large nationwide studies of meningiomas have evaluated overall survival, progression-free survival has yet to be thoroughly examined. This study suggests that even histologically benign meningiomas may have a sex difference in postoperative behavior. This observation may provide clues to understanding the mechanism of meningioma cell proliferation.