Incidence and Survival of Benign, Borderline, and Malignant Meningioma Patients in the United States from 2004 to 2018

Clinical predictors of overall survival in very elderly meningioma patients: a surveillance, epidemiology, and end results (SEER) database analysis

OBJECTIVE

Surgical resection is the gold standard of management for symptomatic intracranial meningiomas. However, surgical intervention may be contraindicated in very elderly patients. In this study, we assessed the survival outcomes for elderly and very elderly patients and the impact of surgical intervention [e.g., subtotal resection (STR) and gross total resection (GTR)] and radiotherapy (RT).

METHODS

The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify all patients ≥ 65 years of age diagnosed with intracranial meningiomas between 2000 and 2020. Baseline demographics, clinical characteristics, and survival outcomes were compared between elderly (65-79 years) and very elderly (80 + years) patients.

RESULTS

4,052 intracranial meningioma patients were identified- 3,462 elderly patients and 590 very elderly patients. Very elderly patients were less likely to undergo GTR compared to elderly patients (OR: 0.756, 95% CI: 0.631-0.905, p = 0.002) and less likely to receive RT (OR: 0.441, 95% CI: 0.294-0.642, p < 0.001). Achievement of GTR in very elderly patients did not decrease the risk of death (HR: 1.003, 95% CI: 0.682-1.475, p = 0.987). However, RT was associated with decreased risk of death in very elderly patients (HR: 0.212, 95% CI: 0.052-0.860, p = 0.030).

CONCLUSION

In this retrospective study, we found pursual of aggressive surgical intervention in very elderly patients was not associated with increased mortality. Despite very elderly patients being much less likely to be prescribed radiotherapy, the administration of RT significantly increased overall survival, suggesting a greater role for radiotherapy in managing intracranial meningiomas in the very elderly population.

Development of a clinical-radiological nomogram for predicting severe postoperative peritumoral brain edema following intracranial meningioma resection

Objective

The goal of this study was to develop a nomogram that integrates clinical data to predict the likelihood of severe postoperative peritumoral brain edema (PTBE) following the surgical removal of intracranial meningioma.

Method

We included 152 patients diagnosed with meningioma who were admitted to the Department of Neurosurgery at the Affiliated People's Hospital of Jiangsu University between January 2016 and March 2023. Clinical characteristics were collected from the hospital's medical record system. Factors associated with severe postoperative PTBE were identified through univariate and LASSO regression analyses of clinical, pathological, and radiological features. A multivariate logistic regression analysis was then performed incorporating all features. Based on these analyses, we developed five predictive models using R software: conventional logistic regression, XGBoost, random forest, support vector machine (SVM), and k-nearest neighbors (KNN). Model performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and conducting decision curve analysis (DCA). The most optimal model was used to create a nomogram for visualization. The nomogram was validated using both a validation set and clinical impact curve analysis. Calibration curves assessed the accuracy of the clinical-radiomics nomogram in predicting outcomes, with Brier scores used as an indicator of concordance. DCA was employed to determine the clinical utility of the models by estimating net benefits at various threshold probabilities for both training and testing groups.

Results

The study involved 151 patients, with a prevalence of severe postoperative PTBE at 35.1%. Univariate logistic regression identified four potential risk factors, and LASSO regression identified four significant risk factors associated with severe postoperative PTBE. Multivariate logistic regression revealed three independent predictors: preoperative edema index, tumor enhancement intensity on MRI, and the number of large blood vessels supplying the tumor. Among all models, the conventional logistic model showed the best performance, with AUCs of 0.897 (95% CI: 0.829-0.965) and DCA scores of 0.719 (95% CI: 0.563-0.876) for each cohort, respectively. We developed a nomogram based on this model to predict severe postoperative PTBE in both training and testing cohorts. Calibration curves and Hosmer-Lemeshow tests indicated excellent agreement between predicted probabilities and observed outcomes. The Brier scores were 10.7% (95% CI: 6.7-14.7) for the training group and 25% (95% CI: 15.2-34.8) for the testing group. DCA confirmed that the nomogram provided superior net benefit across various risk thresholds for predicting severe postoperative PTBE, with a threshold probability range from 0 to 81%.

Conclusion

Utilizing conventional logistic regression within machine learning frameworks, we developed a robust prediction model. The clinical-radiological nomogram, based on conventional logistic regression, integrated clinical characteristics to enhance the prediction accuracy for severe PTBE in patients following intracranial meningioma resection. This nomogram showed promise in aiding clinicians to create personalized and optimal treatment plans by providing precise forecasts of severe PTBE.

High-Dose Cyproterone Acetate and Intracranial Meningioma: Impact of the Risk Minimisation Measures Implemented in France in 2018-2019

PURPOSE

To measure the impact of national regulatory actions implemented in France in August 2018 and June 2019 to reduce the risk of meningioma associated with the use of cyproterone acetate (CPA).

METHODS

Using the French National Healthcare database, we calculated the monthly number of CPA users among cisgender women, men and transgender women in 2010-2021, the monthly proportion of users with cerebral imaging screening, and the annual rate of meningioma surgery associated with CPA use. CPA discontinuations and switches were analysed.

RESULTS

Between 2018 and 2021, the number of individuals exposed to CPA fell by 85% (55 000 in August 2018 versus 7900 users of high-dose CPA in December 2021), corresponding to two waves of decrease in both use and initiation. This drop was greater among cisgender women (88%) than men (69%) or transgender women (50%). Cerebral imaging screening increased from 11% in June 2018 to 70% in June 2021 for ciswomen (13%-51% for men, 9%-60% for transwomen). After CPA discontinuation, no massive shift to a single product was observed, but, instead, dispersion towards other hormonal therapies. The overall annual rate of meningioma surgery associated with CPA exposure spectacularly decreased between 2017 and 2021 (-93% for ciswomen and -86% for men).

CONCLUSION

In France, high-dose CPA use sharply decreased after the implementation of national regulatory measures without a massive switch to other hormonal therapies. The increase in cerebral imaging screening did not result in an increase in meningioma surgery associated with CPA, but rather a massive drop of over 90%.

Paediatric meningiomas: a multi-centre case series of 27 patients

PURPOSE

This study presents a series of paediatric meningiomas and discusses aetiology, risk factors and outcomes with comparison to current literature.

METHODS

This is a retrospective review of surgically treated paediatric meningiomas from three UK centres: the University Hospital of Wales, Alder Hey Children's Hospital and Royal Manchester Children's Hospital. Twenty-seven patients aged 16 and under at the time of their first procedure were identified over a 15-year period (1 January 2007 and 1 March 2023). Electronic medical records were used to collect data on age at presentation, sex, location of tumour(s), extent of resection, histology, WHO grade, complications, outcomes and associated conditions, notably neurofibromatosis type 2 (NF2).

RESULTS

Twenty-seven patients underwent 39 procedures. There were 13 males and 14 females. The median age was 13 years (range, 8 months to 16 years). Twenty-one (75%) were WHO grade 1, 6 (21%) were grade 2 and 1 (4%) was grade 3. Eight patients (30%) had confirmed NF2. Twelve patients (44%) were sporadic cases. Twenty-five percent and 50% were the recurrence rate in WHO grade 1 and 2 tumours, respectively.

CONCLUSION

The risk of grade 1 tumour recurrence was higher than within the adult population. This may be due to histological features of paediatric meningiomas differing from the adult population, and therefore, the WHO grading system may not be reflective of recurrence risk. Future molecular profiling and larger studies are required given the rarity of these cases.

Postoperative peritumoral edema is correlated with the prognosis in intracranial meningioma with preoperative peritumoral edema

Preoperative peritumoral edema (PTE) in intracranial meningiomas is known to be a risk factor for postoperative recurrence. However, there are two groups: those in which preoperative PTE remains and those in which preoperative PTE receded after tumor removal. We aimed to investigate whether postoperative PTE could improve the prediction of prognosis of meningioma with preoperative PTE. We retrospectively reviewed postoperative MRI scans in 3 months after operation of 371 patients with preoperative PTE of meningioma that underwent surgery between 2015 and 2017. All the patients were classified into two different groups according to whether had postoperative PTE receded within 3 months after operation. Clinical manifestations, histopathology characteristics, radiology data and follow-up outcomes were noted. student's t-test and chi-square test for independence were used to compare clinical characteristics. Univariate and multivariate Cox analysis and Kaplan‒Meier methods were utilized to determine the independent effect of postoperative PTE on postoperative recurrence. Multivariate Cox analyses showed that the risk factors of meningioma recurrence: high WHO grades (HR = 4.989, P<0.001), superior sagittal sinus invasion (HR = 2.290, P = 0.047), postoperative PTE in 3 months after operation (HR = 1.804, P = 0.044) and STR (HR = 3.940, P = 0.003). Kaplan-Meier model showed that the progression-free survival of patients with postoperative PTE are shorter than who with postoperative PTE receded in 3 months after operation (HR = 3.30, P = 0.006). According to our research, we found that postoperative PTE in 3 months after operation is related to the outcomes of meningioma with preoperative PTE. Besides, we demonstrated that there were also some factors for recurrence: male, high WHO grades, superior sagittal sinus invasion and STR. These findings highlight the need for prospective study.

Epidemiological trends and factors associated with survival in patients with medulloblastoma: A 45-year population-based retrospective study

Medulloblastoma (MB) is a primary brain malignancy. However, updated epidemiological data and long-term outcomes are lacking.The clinical and epidemiological datasets of patients with MB in the current study were obtained from the Surveillance, Epidemiology, and End Results (SEER) databases. Joinpoint regression models were used to assess the rate of changes in the incidence, prevalence, and treatment trends in patients with MB. Cox hazard and competition risk model analyses were used to assess overall survival (OS) and cancer-specific survival (CSS).The age-adjusted incidence of MB remained relatively stable at 0.15 per 100,000 individuals in 2019. The annual percentage change (APC) of females remained stable, whereas that of males increased over time. The 20-year limited-duration prevalence of patients with MB increased significantly from 0.00016 % in 1999 to 0.00203 % in 2018. Patients aged 5-19 years accounted for 46.7 % of all age groups, and the trend for the three treatments was increased. Average annual percentage change (AAPC) for the chemotherapy group was increased in patients aged 20 + years MB [AAPC = 2.66 (95 % CI 0.93-6.31)]. Multivariate analysis revealed that OS and CSS varied significantly according to age, year of diagnosis, histology, stage, surgery, and radiotherapy. Subgroup analysis showed that chemotherapy was associated with a favorable prognosis in high-risk groups.The incidence of MB remained relatively stable, and its prevalence increased significantly. This current population-based study further identified the prognostic factors in patients with MB. Moreover, the use of chemotherapy was associated with better survival in high-risk groups.

Atypical and anaplastic meningiomas in the later decades of life: A national cancer database analysis

PURPOSE

We conducted a National Cancer Database (NCDB) study to investigate the epidemiological characteristics and identify predictors of outcomes associated with geriatric meningiomas.

METHODS

The NCDB was queried for adults aged 60-89 years diagnosed between 2010 and 2017 with grade 2 and 3 meningiomas. The patients were classified into three age groups based on their age: 60-69 (hexagenarians), 70-79 (septuagenarians), and 80-89 (octogenarians). The log-rank test was utilized to compare the differences in overall survival (OS). Univariate and multivariate Cox proportional hazards regressions were used to evaluate the mortality risk associated with various patient and disease parameters.

RESULTS

A total of 6585 patients were identified. Hexagenerians were the most common age group (49.8%), with the majority of meningiomas being classified as grade 2 (89.5%). The incidence of high-grade meningiomas increased in all age groups during the study period. Advanced age, male sex, black race, lower socioeconomic status, Charlson-Deyo score ≥ 2, and higher tumor grade were independent factors of poor survival. Among the modes of treatment, the extent of surgical resection, adjuvant radiotherapy, and treatment at a noncommunity cancer program were linked with better outcomes.

CONCLUSION

In geriatric patients with high-grade meningiomas, the greater extent of surgical resection and radiotherapy are associated with improved survival. However, the management and outcome of geriatric patients with higher-grade meningiomas are also associated with several socioeconomic factors.

Treatment of Meningiomas Involving the Optic Canal with Endoscopic Transnasal Decompression of the Optic Nerve

BACKGROUND

Management of patients with optic nerve sheath meningiomas (ONSMs) is controversial and the treatment strategy in this patient group is still up for discussion. Transnasal endoscopic orbital and optic nerve decompression aims to reduce the pressure in the orbit and on the optic nerve and thereby prevent vision loss. This article presents material from 7 cases of transnasal endoscopic orbital decompression.

METHODS

The study design is a retrospective cohort study. The aim was to include all patients with a meningioma residing along the nerve sheath and who were operated using endoscopic transnasal decompression of the orbit and if needed the optic canal at Odense University Hospital. Data from the medical records were collected and pre- and postoperative eye examinations were compared. In addition, it was recorded whether there were complications to the procedure and whether additional treatments were given.

RESULTS

In total, 4 women and 3 men were included in the study. Four out of 7 patients experienced improvement in vision after the operation. One patient experienced unchanged vision and 2 patients experienced deterioration of vision after surgery.

CONCLUSIONS

The current report of 7 patients with ONSM shows promising results for this surgical procedure as 4 out of 7 patients experienced improvement in their vision at follow-up examinations. The 2 patients who experienced deterioration of vision already had severely reduced vision preoperatively, which indicates that surgery should be considered before the vision becomes significantly reduced.

Bridging the gap: exploring the causal relationship between metformin and tumors

Objective

Numerous studies have reported that metformin can reduce the risk of tumor development. However, some of the results of these studies are conflicting, necessitating a more reliable evaluation.

Methods

We conducted a Mendelian randomization phenome-wide association study (MR-PheWAS) of tumors to explore the causal relationship between metformin and tumors. Two cohorts of patients taking metformin were obtained from the UK Biobank. Complete phenotype data of the tumors were obtained from FinnGen_R10. We elucidated the causal relationship using a two-sample Mendelian randomization (MR) analysis. More importantly, we conducted a meta-analysis to ensure relatively unbiased results. In the MR analysis, we used the inverse-variance weighted (IVW) method as the main outcome indicator. Subsequently, two cohorts were integrated for the meta-analysis. Finally, we investigated the mechanisms through mediational MR analysis.

Results

MR analysis revealed that metformin might have a causal relationship with 13 tumor-associated phenotypes in the training cohort. Four phenotypes were validated in the testing cohort. In the training and testing cohorts, metformin exhibited a protective effect against brain meningiomas and malignant neoplasms of the breast (HER-positive), oral cavity, tonsils, and the base of the tongue. Intriguingly, after integrating the results of the two cohorts for the meta-analysis, 12 results were statistically significant. Mediational MR analysis suggested that the effects of metformin on brain meningiomas may be weakened by the presence of the family Oxalobacteraceae.

Conclusion

Metformin exhibits potential preventive and therapeutic effects on four types of tumors: brain meningioma, malignant neoplasms of the breast (HER-positive), oral cavity and tonsils, and the base of the tongue. Large randomized controlled trials are required to confirm these findings.

Bone metastases in oral squamous cell carcinoma: A real-world retrospective study based on the SEER database

BACKGROUND

Bone metastases are rare in oral squamous cell carcinoma (OSCC). It has not been defined on the risk and prognosis of OSCC patients with bone metastases. The purpose of this study was to assess the factors associated with the development and prognosis of bone metastases among OSCC patients.

METHODS

Demographic and clinicopathological characteristics of OSCC patients diagnosed between 2010 and 2019 was retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. To explore risk factors for developing bone metastases and prognosis, the univariate and multivariate logistic and Cox regression analysis were performed, further the predictive nomogram models were constructed.

RESULTS

The incidence rate of bone metastases in newly diagnosed OSCC patients was 0.91 % (95 %CI 0.81% -1.02 %). Ultimately, 137 OSCC patients with bone metastases and 19,469 OSCC patients without bone metastases were included in the present study. Pathological grade, primary site, T/N stage and distant organ metastases (liver/lung/brain) were independently associated with the risk of developing bone metastases among OSCC patients. The C-index of a constructed risk-predicting nomogram was 0.86 (95 %CI 0.83-0.89). Multivariate Cox regression analysis indicated that lung metastases, the use of surgery as well as chemotherapy were three independent prognostic factors. The C-indexes of constructed risk-predicting nomograms were 0.70 (95 %CI 0.65-0.75), 0.68 (95 %CI 0.63-0.73) for OS and CSS, respectively. Calibration plots demonstrated an agreementbetween the established nomogram's predicted survival and actual survival. In addition, decision curve analysis (DCA) indicated these established nomograms had considerable net benefits and clinical utilities.

CONCLUSION

This study defined the risk and prognostic factors for bone metastases among OSCC patients and the established nomograms were well calibrated for discrimination to predict bone metastasis development and prognosis.

Predicting histological grade in symptomatic meningioma by an objective estimation of the tumoral surface irregularity

INTRODUCTION

Predicting the histopathologic grade of meningioma is relevant because local recurrence is significantly greater in WHO grade II-III compared to WHO grade I tumours, which would ideally benefit from a more aggressive surgical strategy. It has been suggested that higher WHO grade tumours are more irregularly-shaped. However, irregularity is a subjective and observer-dependent feature. In this study, the tumour surface irregularity of a large series of meningiomas, measured upon preoperative MRI, is quantified and correlated with the WHO grade.

METHODS

Unicentric retrospective observational study of a cohort of symptomatic meningiomas surgically removed in the time period between January 2015 and December 2022. Using specific segmentation software, the Surface Factor (SF) was calculated for each meningioma. SF is an objective parameter that compares the surface of a sphere (minimum surface area for a given volume) with the same volume of the tumour against the actual surface of the tumour. This ratio varies from 0 to 1, being 1 the maximum sphericity. Since irregularly-shaped meningiomas present proportionally greater surface area, the SF tends to decrease as irregularity increases. SF was correlated with WHO grade and its predictive power was estimated with ROC curve analysis.

RESULTS

A total of 176 patients (64.7% females) were included in the study; 120 WHO grade I (71.9%), 43 WHO grade II (25.7%) and 4 WHO grade III (2.4%). A statistically significant difference was found between the mean SF of WHO grade I and WHO grade II-III tumours (0.8651 ± 0.049 versus 0.7081 ± 0.105, p < 0.0001). Globally, the SF correctly classified more than 90% of cases (area under ROC curve 0.940) with 93.3% sensibility and 80.9% specificity. A cutoff value of 0.79 yielded the maximum precision, with positive and negative predictive powers of 82.6% and 92.6%, respectively. Multivariate analysis yielded SF as an independent prognostic factor of WHO grade.

CONCLUSION

The Surface Factor is an objective and quantitative parameter that helps to identify aggressive meningiomas preoperatively. A cutoff value of 0.79 allowed differentiation between WHO grade I and WHO grade II-III with high precision.

Use of progestogens and the risk of intracranial meningioma: national case-control study

OBJECTIVE

To assess the risk of intracranial meningioma associated with the use of selected progestogens.

DESIGN

National case-control study.

SETTING

French National Health Data System (ie, Système National des Données de Santé).

PARTICIPANTS

Of 108 366 women overall, 18 061 women living in France who had intracranial surgery for meningioma between 1 January 2009 and 31 December 2018 (restricted inclusion periods for intrauterine systems) were deemed to be in the case group. Each case was matched to five controls for year of birth and area of residence (90 305 controls).

MAIN OUTCOME MEASURES

Selected progestogens were used: progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest, and intrauterine levonorgestrel. For each progestogen, use was defined by at least one dispensation within the year before the index date (within three years for 13.5 mg levonorgestrel intrauterine systems and five years for 52 mg). Conditional logistic regression was used to calculate odds ratio for each progestogen meningioma association.

RESULTS

Mean age was 57.6 years (standard deviation 12.8). Analyses showed excess risk of meningioma with use of medrogestone (42 exposed cases/18 061 cases (0.2%) v 79 exposed controls/90 305 controls (0.1%), odds ratio 3.49 (95% confidence interval 2.38 to 5.10)), medroxyprogesterone acetate (injectable, 9/18 061 (0.05%) v 11/90 305 (0.01%), 5.55 (2.27 to 13.56)), and promegestone (83/18 061 (0.5%) v 225/90 305 (0.2 %), 2.39 (1.85 to 3.09)). This excess risk was driven by prolonged use (≥one year). Results showed no excess risk of intracranial meningioma for progesterone, dydrogesterone, or levonorgestrel intrauterine systems. No conclusions could be drawn concerning dienogest or hydroxyprogesterone because of the small number of individuals who received these drugs. A highly increased risk of meningioma was observed for cyproterone acetate (891/18 061 (4.9%) v 256/90 305 (0.3%), odds ratio 19.21 (95% confidence interval 16.61 to 22.22)), nomegestrol acetate (925/18 061 (5.1%) v 1121/90 305 (1.2%), 4.93 (4.50 to 5.41)), and chlormadinone acetate (628/18 061 (3.5%) v 946/90 305 (1.0%), 3.87 (3.48 to 4.30)), which were used as positive controls for use.

CONCLUSIONS

Prolonged use of medrogestone, medroxyprogesterone acetate, and promegestone was found to increase the risk of intracranial meningioma. The increased risk associated with the use of injectable medroxyprogesterone acetate, a widely used contraceptive, and the safety of levonorgestrel intrauterine systems are important new findings.

Epidemiology and survival of patients with spinal meningiomas: a large retrospective cohort study

INTRODUCTION

Spinal meningiomas (SMs) are relatively rare central nervous system tumors that usually trigger neurological symptoms. The prevalence of SMs is increasing with the aging of the global population. This study aimed to perform a systematic epidemiologic and survival prognostic analysis of SMs to evaluate their public health impact and to develop a novel method to estimate the overall survival at 3-year, 5-year, and 10-year in patients with SMs.

METHODS

Five thousand one hundred fifty eight patients with SMs were recruited from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2019. Firstly, descriptive analysis was performed on the epidemiology of SMs. Secondly, these individuals were randomly allocated to the training and validation sets in a ratio of 7:3. Kaplan-Meier method and Cox regression analysis were utilized in the training set to identify independent prognostic factors and to construct a nomogram for survival prognosis. Subsequently, the discriminative power, predictive performance, and clinical utility of the nomogram were evaluated by receiver operating characteristic curve and decision curve analysis. Finally, a mortality risk stratification system and a web-based dynamic nomogram were constructed to quantify the risk of mortality in patients with SMs.

RESULTS

The annual age-adjusted incidence rates of SMs increased steadily since 2004, reaching a rate of 0.40 cases per 100 000 population in 2019, with a female-to-male ratio of ~4:1. The age groups of 50-59, 60-69, and 70-79 years old were the most prevalent ages for SMs, accounting for 19.08, 24.93, and 23.32%, respectively. In addition, seven independent prognostic factors were identified to establish a prognostic nomogram for patients with SMs. The decision curve analysis and receiver operating characteristic curve indicated that the nomogram had high clinical utility and favorable accuracy. Moreover, the mortality risk stratification system effectively divided patients into low-risk, middle-risk, and high-risk subgroups.

CONCLUSIONS

SMs are relatively rare benign spinal tumors prevalent in the white elderly female population. Clinicians could use the nomogram to personalize the prediction of the overall survival probability of patients with SMs, categorize these patients into different mortality risk subgroups, and develop personalized decision-making plans. Moreover, the web-based dynamic nomogram could help to further promote clinical application and assist clinicians in providing personalized counseling, timely monitoring, and clinical assessment for patients.

Risk factors on surgical compliance and its impact on survival outcomes in meningioma patients: a SEER-based retrospective propensity-score matched analysis

BACKGROUND

This study aimed to analyze the effect of surgical compliance on the survival outcome of patients with meningioma and explore the factors affecting surgical compliance.

METHODS

We selected data from the Surveillance, Epidemiology, and End Results database for 122,632 meningioma patients diagnosed between 2004 and 2018. The effect of surgical compliance on patients' overall survival (OS) was analyzed through Cox regression and Kaplan-Meier curves. Independent risk factors for surgical compliance were identified through multifactorial logistic regression analyses to construct diagnostic nomograms, further assessed by receiver operating characteristic curves. Furthermore, we used univariate and multivariate logistic regression analyses to evaluate relevant variables linked to adherence with meningioma surgery. Moreover, 1:1 propensity score matching was applied to assess the validity of the results in patients with favorable and poor surgical compliance.

RESULTS

A total of 48,735 were eligible from the initial cohort of 122,632 patients with meningioma. Among them, 45,038 (92.40%) exhibited good surgical compliance, while 3697 (7.60%) had poor surgical compliance. The rate of patients with good surgical compliance was significantly higher than that of patients with inadequate surgical compliance (p < 0.001). Moreover, surgical compliance is an independent prognostic factor for OS in meningioma patients. Univariate Cox regression analysis indicated that individuals with poor surgical compliance demonstrated lower OS rates than those with good surgical compliance (hazard ratio [HR 2.404; 95% confidence interval [CI] 2.276-2.54, p < 0.001], consistent with the observation in the multivariate analysis (HR 1.564; 95% CI 1.471-1.663, p < 0.001). We developed a prediction model using seven variables: age, sex, race, tumor behavior recode, tumor size, family income, and residential setting (p < 0.05). Surgical compliance was associated with patient age, sex, race, tumor behavior recode, tumor size, family income, and residential setting by logistic regression analysis.

CONCLUSIONS

Surgical compliance emerged as an independent prognostic factor for survival in patients with meningioma. Poor surgical compliance was associated with older age, black and other races, females, advanced-stage tumors, larger tumor size, lower household income, and rural residence. When patients experienced these conditions, OS was shorter, requiring more aggressive treatment.

Surveillance, Epidemiology, and End Results database and propensity score matching analysis of postoperative radiotherapy for non-malignant meningioma: A retrospective cohort study

BACKGROUND

The clinical effect of postoperative radiotherapy (PORT) in non-malignant meningioma (NMM) has not been well explored.

METHODS

A total of 8629 patients with NMM (surgery alone group: n = 7716, postoperative radiotherapy group: n = 913) were obtained from the Surveillance, Epidemiology, and End Results database. Patient profiles were matched by 1:1 propensity score matching (PSM). Logistic regression analysis was performed to identify factors associated with PORT versus surgery alone (SA). Univariate and multivariate Cox regression analyses determined prognostic variables with overall survival (OS) in NMM. Subgroup analyses were performed with Cox proportional hazards regression models.

RESULTS

All the SA (n = 7716) and PORT (n = 913) groups were included. Women with PORT (66.3%) and SA (70.9%) were almost twice as likely as men, and tumors with benign behaviors in the SA group were almost seven times more frequent than those with malignant characteristics. We explored the demographic, clinical characteristics, and prognostic factors in NMM. Laterality, surgery, tumor size, diagnosis year, age, and tumor behavior were associated with PORT versus SA. Patients treated with PORT had better OS than those treated with SA (p = 0.03). After PSM, PORT remained comparable to SA (hazard ratio 0.56, 95% confidence interval 0.35-0.88, p = 0.013). In the subgroup analysis of PORT treatment, borderline malignant behavior increased the death risk by 23%, while other variables did not have a significant clinical benefit (p > 0.05).

CONCLUSIONS

Borderline malignant behavior should be considered seriously, and the PORT regimen should be actively implemented for patients with benign meningiomas.

Epidemiology and survival of non-malignant and malignant meningiomas in middle-aged females, 2004-2018

Background

The incidence of meningioma is disparate to sex: meningiomas are more common in women than in men, especially in middle-aged women. Understanding the epidemiology and survival of middle-aged women with meningiomas would help estimate their public health impacts and optimize risk stratification.

Methods

Data on middle-aged (35-54 years) female patients with meningiomas between 2004 and 2018 were obtained from the SEER database. Age-adjusted incidence rates per 100 000 population-years were calculated. Kaplan-Meier and multivariate Cox proportional hazard models were utilized in the overall survival (OS) analysis.

Results

Data from 18302 female patients with meningioma were analyzed. The distribution of patients increased with age. Most patients were White and non-Hispanic, according to race and ethnicity, respectively. Over the past 15 years, non-malignant meningiomas have shown an increasing trend; however, malignant meningiomas have shown an opposite trend. Older age, Black population, and large non-malignant meningiomas tend to have worse prognoses. Surgical resection improves OS, and the extent of resection is a critical prognostic factor.

Conclusions

This study observed an increase in non-malignant meningiomas and a decrease in the incidence of malignant meningiomas in middle-aged females. The prognosis deteriorated with age, in Black people, and with large tumor size. Additionally, the extent of tumor excision was found to be a significant prognostic factor.

Epidemiology and risk stratification of low-grade gliomas in the United States, 2004-2019: A competing-risk regression model for survival analysis

Background

Understanding the epidemiology and prognostic factors of low-grade gliomas (LGGs) can help estimate the public health impact and optimize risk stratification and treatment strategies.

Methods

3 337 patients diagnosed with LGGs were collected from the Surveillance, Epidemiology, and End Results (SEER) dataset, 2004-2019. The incidence trends of LGGs were analyzed by patient demographics (sex, age, race, and ethnicity). In addition, a competing risk regression model was used to explore the prognostic factors of LGGs by patient demographics, tumor characteristics (histological subtypes, invasiveness, and size), treatment modality, and molecular markers (IDH mutation and 1p/19q codeletion).

Results

LGGs occurred more frequently in male, non-Hispanic, and White populations. The incidence rate of mixed gliomas was stable from 2004 to 2013 and decreased dramatically to nearly zero until 2019. The risk of death increased 1.99 times for every 20-year increase in patient age, and 60 years is a predictive cut-off age for risk stratification of LGGs. Male patients showed poorer LGG-specific survival. Among the different subtypes, astrocytoma has the worst prognosis, followed by mixed glioma and oligodendroglioma. Tumors with larger size (≥5 cm) and invasive behavior tended to have poorer survival. Patients who underwent gross total resection had better survival rates than those who underwent subtotal resection. Among the different treatment modalities, surgery alone had the best survival, followed by surgery + radiotherapy + chemotherapy, but chemotherapy alone had a higher death risk than no treatment. Furthermore, age, invasiveness, and molecular markers were the most robust prognostic factors.

Conclusion

This study reviewed the incidence trends and identified several prognostic factors that help clinicians identify high-risk patients and determine the need for postoperative treatment according to guidelines.