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Nguyen P, Roland N, Neumann A, Hoisnard L, Passeri T, Duranteau L, Coste J, Froelich S, Zureik M, Weill A. Prolonged use of nomegestrol acetate and risk of intracranial meningioma: a population-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100928. [PMID: 38800110 PMCID: PMC11127190 DOI: 10.1016/j.lanepe.2024.100928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
Background Nomegestrol acetate (NOMAC) is a synthetic potent progestogen. This study aimed to assess the risk of intracranial meningioma associated with the prolonged use of NOMAC. Methods Observational cohort study using SNDS data (France). Women included had ≥ one dispensing of NOMAC between 2007 and 2017 (no dispensing in 2006). Exposure was defined as a cumulative dose >150 mg NOMAC within six months after first dispensing. A control group of women (cumulative dose ≤150 mg) was assembled. The outcome was surgery (resection or decompression) or radiotherapy for one or more intracranial meningioma(s). Poisson models assessed the relative risk (RR) of meningioma. Findings In total, 1,060,779 women were included in the cohort (535,115 in the exposed group and 525,664 in the control group). The incidence of meningioma in the two groups was 19.3 and 7.0 per 100,000 person-years, respectively (age-adjusted RRa = 2.9 [2.4-3.7]). The RRa for a cumulative dose of more than 6 g NOMAC was 12.0 [9.9-16.0]. In the event of treatment discontinuation for at least one year, the risk of meningioma was identical to that in the control group (RRa = 1.0 [0.8-1.3]). The location of meningiomas in the anterior and middle part of the skull base was more frequent with exposure to NOMAC. Interpretation We observed a strong dose-dependent association between prolonged use of NOMAC and the risk of intracranial meningiomas. These results are comparable to those obtained for cyproterone acetate, although the magnitude of the risk is lower. It is now recommended to stop using NOMAC if a meningioma is diagnosed. Funding The French National Health Insurance Fund (Cnam) and the French National Agency for Medicines and Health Products Safety (ANSM) via the Health Product Epidemiology Scientific Interest Group EPI-PHARE.
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Affiliation(s)
- Pierre Nguyen
- EPI-PHARE Scientific Interest Group (French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance), Saint-Denis, France
| | - Noémie Roland
- EPI-PHARE Scientific Interest Group (French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance), Saint-Denis, France
| | - Anke Neumann
- EPI-PHARE Scientific Interest Group (French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance), Saint-Denis, France
| | - Léa Hoisnard
- EpiDermE Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris Est Créteil University (UPEC), Créteil, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Lise Duranteau
- Department of Medical Gynaecology, Bicêtre Hospital, AP-HP, Paris Saclay University, 94270, Le Kremlin-Bicêtre, France
| | - Joël Coste
- Biostatistics and Epidemiology Unit, Cochin Hospital, AP-HP, Paris, France
- Paris Cité University, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group (French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance), Saint-Denis, France
- Versailles St-Quentin-en-Yvelines University, Montigny le Bretonneux, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group (French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance), Saint-Denis, France
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Price M, Neff C, Nagarajan N, Kruchko C, Waite KA, Cioffi G, Cordeiro BB, Willmarth N, Penas-Prado M, Gilbert MR, Armstrong TS, Barnholtz-Sloan JS, Ostrom QT. CBTRUS Statistical Report: American Brain Tumor Association & NCI Neuro-Oncology Branch Adolescent and Young Adult Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2016-2020. Neuro Oncol 2024; 26:iii1-iii53. [PMID: 38709657 PMCID: PMC11073545 DOI: 10.1093/neuonc/noae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
Recent analyses have shown that, whereas cancer survival overall has been improving, it has not improved for adolescents and young adults ages 15-39 years (AYA). The clinical care of AYA with primary brain and other central nervous system (CNS) tumors (BT) is complicated by the fact that the histopathologies of such tumors in AYA differ from their histopathologies in either children (ages 0-14 years) or older adults (ages 40+ years). The present report, as an update to a 2016 publication from the Central Brain Tumor Registry of the United States and the American Brain Tumor Association, provides in-depth analyses of the epidemiology of primary BT in AYA in the United States and is the first to provide biomolecular marker-specific statistics and prevalence by histopathology for both primary malignant and non-malignant BT in AYA. Between 2016 and 2020, the annual average age-specific incidence rate (AASIR) of primary malignant and non-malignant BT in AYA was 12.00 per 100,000 population, an average of 12,848 newly diagnosed cases per year. During the same period, an average of 1,018 AYA deaths per year were caused by primary malignant BT, representing an annual average age-specific mortality rate of 0.96 per 100,000 population. When primary BT were categorized by histopathology, pituitary tumors were the most common (36.6%), with an AASIR of 4.34 per 100,000 population. Total incidence increased with age overall; when stratified by sex, the incidence was higher in females than males at all ages. Incidence rates for all primary BT combined and for non-malignant tumors only were highest for non-Hispanic American Indian/Alaska Native individuals, whereas malignant tumors were more frequent in non-Hispanic White individuals, compared with other racial/ethnic groups. On the basis of histopathology, the most common molecularly defined tumor was diffuse glioma (an AASIR of 1.51 per 100,000). Primary malignant BT are the second most common cause of cancer death in the AYA population. Incidence rates of primary BT overall, as well as specific histopathologies, vary significantly by age. Accordingly, an accurate statistical assessment of primary BT in the AYA population is vital for better understanding the impact of these tumors on the US population and to serve as a reference for afflicted individuals, for researchers investigating new therapies, and for clinicians treating these patients.
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Affiliation(s)
- Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Brittany B Cordeiro
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
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3
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Sharma S, Rana R, Prakash P, Ganguly NK. Drug target therapy and emerging clinical relevance of exosomes in meningeal tumors. Mol Cell Biochem 2024; 479:127-170. [PMID: 37016182 PMCID: PMC10072821 DOI: 10.1007/s11010-023-04715-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
Meningioma is the most common central nervous system (CNS) tumor. In recent decades, several efforts have been made to eradicate this disease. Surgery and radiotherapy remain the standard treatment options for these tumors. Drug therapy comes to play its role when both surgery and radiotherapy fail to treat the tumor. This mostly happens when the tumors are close to vital brain structures and are nonbenign. Although a wide variety of chemotherapeutic drugs and molecular targeted drugs such as tyrosine kinase inhibitors, alkylating agents, endocrine drugs, interferon, and targeted molecular pathway inhibitors have been studied, the roles of numerous drugs remain unexplored. Recent interest is growing toward studying and engineering exosomes for the treatment of different types of cancer including meningioma. The latest studies have shown the involvement of exosomes in the theragnostic of various cancers such as the lung and pancreas in the form of biomarkers, drug delivery vehicles, and vaccines. Proper attention to this new emerging technology can be a boon in finding the consistent treatment of meningioma.
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Affiliation(s)
- Swati Sharma
- Department of Research, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Rashmi Rana
- Department of Research, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Prem Prakash
- Department of Molecular Medicine, Jamia Hamdard, New Delhi, 110062 India
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Caruso G, Ferrarotto R, Curcio A, Metro L, Pasqualetti F, Gaviani P, Barresi V, Angileri FF, Caffo M. Novel Advances in Treatment of Meningiomas: Prognostic and Therapeutic Implications. Cancers (Basel) 2023; 15:4521. [PMID: 37760490 PMCID: PMC10526192 DOI: 10.3390/cancers15184521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Meningiomas are the most frequent histotypes of tumors of the central nervous system. Their incidence is approximately 35% of all primary brain tumors. Although they have the status of benign lesions, meningiomas are often associated with a decreased quality of life due to focal neurological deficits that may be related. The optimal treatment is total resection. Histological grading is the most important prognostic factor. Recently, molecular alterations have been identified that are specifically related to particular phenotypes and, probably, are also responsible for grading, site, and prognostic trend. Meningiomas recur in 10-25% of cases. In these cases, and in patients with atypical or anaplastic meningiomas, the methods of approach are relatively insufficient. To date, data on the molecular biology, genetics, and epigenetics of meningiomas are insufficient. To achieve an optimal treatment strategy, it is necessary to identify the mechanisms that regulate tumor formation and progression. Combination therapies affecting multiple molecular targets are currently opening up and have significant promise as adjuvant therapeutic options. We review the most recent literature to identify studies investigating recent therapeutic treatments recently used for meningiomas.
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Affiliation(s)
- Gerardo Caruso
- Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, 98122 Messina, Italy; (R.F.); (A.C.); (L.M.); (F.F.A.); (M.C.)
| | - Rosamaria Ferrarotto
- Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, 98122 Messina, Italy; (R.F.); (A.C.); (L.M.); (F.F.A.); (M.C.)
| | - Antonello Curcio
- Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, 98122 Messina, Italy; (R.F.); (A.C.); (L.M.); (F.F.A.); (M.C.)
| | - Luisa Metro
- Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, 98122 Messina, Italy; (R.F.); (A.C.); (L.M.); (F.F.A.); (M.C.)
| | | | - Paola Gaviani
- Neuro Oncology Unit, IRCCS Foundation Carlo Besta Neurological Institute, 20133 Milan, Italy;
| | - Valeria Barresi
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, 37134 Verona, Italy;
| | - Filippo Flavio Angileri
- Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, 98122 Messina, Italy; (R.F.); (A.C.); (L.M.); (F.F.A.); (M.C.)
| | - Maria Caffo
- Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, 98122 Messina, Italy; (R.F.); (A.C.); (L.M.); (F.F.A.); (M.C.)
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Wu Y, Xue Y, Wang X, Li J, Qu Y, Zhao T. A pregnant woman with a giant bilateral parietal hemangiopericytoma underwent multiple surgeries and radiotherapy: a case report and literature review. Front Oncol 2023; 13:1172143. [PMID: 37554166 PMCID: PMC10405728 DOI: 10.3389/fonc.2023.1172143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
Intracranial hemangiopericytoma is a rare invasive tumor originating from mesenchymal fibroblasts and is prone to local recurrence and distant metastasis. This study reports a case of a 27-year-old woman who presented with severe headache, nausea and vomiting for two weeks at thirty-three weeks of gestation. Cranial magnetic resonance imaging (MRI) demonstrated a giant lesion in the bilateral parietal lobe with a size of 5.12x9.19x6.03 cm and severe edema in the surrounding brain tissue. The patient underwent four operations and 3 gamma knife radiosurgery procedures and is recovering well now. The histopathology findings showed hemangiopericytoma and STAT6 and CD34 positivity after the first and second surgeries. Because of tumor progression, the patient received gamma knife radiosurgery at 1, 3, and 4 years after the first operation. Total tumor resection was achieved in the fourth surgery. Nevertheless, the patient showed malignant transformation to from low-grade to high-grade hemangiopericytoma.
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Affiliation(s)
- Yingxi Wu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Xinqi Wang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Junting Li
- Department of Pathology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Tianzhi Zhao
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
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Ghimire P, Pang G, Philip J, Hazem S, Rajwani K, Lavrador JP, Grahovac G, Bleil C, Thomas N, Gullan R, Vergani F, Bhangoo R, Ashkan K. Therapeutic Strategies and Challenges in the Management of Craniospinal Tumors in Pregnancy: A Ten-Year Retrospective Tertiary-Center Study, Systematic Review, and Proposal of Treatment Algorithms. World Neurosurg 2023; 171:e213-e229. [PMID: 36481447 DOI: 10.1016/j.wneu.2022.11.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aims to review therapeutic strategies in the management of craniospinal tumors in pregnant patients and the factors that may influence the management along with their influence on maternal and fetal outcomes. METHODS A retrospective single-center cohort study was performed at a tertiary neurosurgical referral center. Pregnant patients referred to the neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumor were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed of the available literature as per PRISMA guidelines. RESULTS Twenty-five patients were identified, with a mean age of 31 years. Of these patients, 88% (n = 22) had cranial lesions and 12% (n = 3) had spinal lesions. Most of the patients had World Health Organization grade I/II tumors. Of the patients, 44% underwent surgery when pregnant, whereas in 40%, this was deferred until after the due date. Of patients, 16% did not require surgical intervention and were followed up with serial imaging in the MDM. The left lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review and retrospective data led to proposal of treatment algorithms addressing the therapeutic strategy for management of craniospinal tumors during pregnancy. Factors that may influence maternal and fetal outcomes during management of these tumors were identified, including aggressiveness of the tumor and stage of pregnancy. CONCLUSIONS Craniospinal tumors presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Factors influencing maternal and fetal outcomes are to be considered during management and patient counseling.
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Affiliation(s)
- Prajwal Ghimire
- King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - Graeme Pang
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jerry Philip
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sally Hazem
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kapil Rajwani
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Gordan Grahovac
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Cristina Bleil
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nicholas Thomas
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gullan
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ranjeev Bhangoo
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- King's College Hospital NHS Foundation Trust, London, United Kingdom; Kings College London, London, United Kingdom
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Abstract
Sex differences play a large role in oncology. It has long been discussed that the incidence of different types of tumors varies by sex, and this holds in neuro-oncology. There are also profound survival sex differences, biologic factors, and treatment effects. This review aims to summarize some of the main sex differences observed in primary brain tumors and goes on to focus specifically on gliomas and meningiomas, as these are two commonly encountered primary brain tumors in clinical practice. Additionally, considerations unique to female individuals, including pregnancy and breastfeeding, are explored. This review sheds light on many of the unique attributes that must be considered when diagnosing and treating female patients with primary brain tumors in clinical practice.
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Affiliation(s)
- Lauren Singer
- Department of Neurology, Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center, The Feinberg School of Medicine/Northwestern University, 675 North Saint Clair Street, Suite 20-100, Chicago, IL 60611, USA.
| | - Ditte Primdahl
- Department of Neurology, Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center, The Feinberg School of Medicine/Northwestern University, 675 North Saint Clair Street, Suite 20-100, Chicago, IL 60611, USA
| | - Priya Kumthekar
- Department of Neurology, Malnati Brain Tumor Institute at the Robert H. Lurie Comprehensive Cancer Center, The Feinberg School of Medicine/Northwestern University, 675 North Saint Clair Street, Suite 20-100, Chicago, IL 60611, USA
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Tumors of the central nervous system among women treated with fertility drugs: a population-based cohort study. Cancer Causes Control 2022; 33:1285-1293. [PMID: 35895242 DOI: 10.1007/s10552-022-01610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/29/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To investigate the association between fertility drugs and tumors of the central nervous system (CNS). METHODS This cohort study was based on The Danish Infertility Cohort and included 148,016 infertile women living in Denmark (1995-2017). The study cohort was linked to national registers to obtain information on use of specific fertility drugs, cancer diagnoses, covariates, emigration, and vital status. Cox proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all CNS tumors and separately for gliomas, meningiomas and diverse benign tumors of the brain and other parts of the CNS. RESULTS During a median 11.3 years of follow-up, 328 women were diagnosed with CNS tumors. No marked associations were observed between use of the fertility drugs clomiphene citrate, gonadotropins, gonadotropin-releasing hormone receptor modulators and progesterone and CNS tumors. However, use of human chorionic gonadotropin was associated with a decreased rate of meningiomas (HR 0.49 95% CI 0.28-0.87). No clear associations with CNS tumors were observed according to time since first use or cumulative dose for any of the fertility drugs. CONCLUSION No associations between use of most types of fertility drugs and CNS tumors were observed. However, our findings only apply to premenopausal women and additional studies with longer follow-up time are necessary.
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Shao C, Tang H, Wang X, He J, Wang P, Wu N. Oral Contraceptive and Glioma Risk: A Prospective Cohort Study and Meta-Analysis. Front Public Health 2022; 10:878233. [PMID: 35910887 PMCID: PMC9330220 DOI: 10.3389/fpubh.2022.878233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Epidemiological evidence that glioma has a slight male predominance implies that factors associated with sex hormones may play a role in the development of glioma. The association between oral contraceptive (OC) use and glioma risk remains controversial. Method In the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial of 70,516 women in the USA, Cox proportional hazards regression analyses were adopted to calculate the crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Additionally, a meta-analysis combining the PLCO findings with those of other prospective cohorts was performed. Results During a mean follow-up of ~11.7 years, 110 of 70,516 women aged 50–78 years at baseline were diagnosed with glioma in PLCO studies. Compared with never users, an inverse association of borderline significance was found for OC users (HR 0.67, 95% CI 0.44–1.04, P = 0.074). Analyses assessing glioma risk according to the duration of OC use yielded no significant association. When PLCO was combined with four other prospective studies, there was an inverse association between OC use and glioma risk (HR 0.85, 95% CI 0.75–0.97, I2 = 0.0%). Further dose-response analysis showed a nonlinear, inverse relationship between OC use and glioma risk (P < 0.001). Conclusions This study provided some evidence of a nonlinear, inverse association between OC use and glioma risk. Future larger studies are warranted to validate this finding.
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Affiliation(s)
- Chuan Shao
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
- Graduate Institute, Chongqing Medical University, Chongqing, China
| | - Hui Tang
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Xiaoya Wang
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Jiaquan He
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
| | - Pan Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- *Correspondence: Pan Wang
| | - Nan Wu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing, China
- Nan Wu
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Murgan N, Harrison B. Interesting presentation of postnatal depression and infant failure to thrive. BMJ Case Rep 2022; 15:e249205. [PMID: 35487627 PMCID: PMC9058715 DOI: 10.1136/bcr-2022-249205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/03/2022] Open
Abstract
This case report is of a woman in her 30s, 10 months post partum who was referred to Mother Baby Unit at a tertiary hospital with depressive symptoms including lowered mood, reduced self-care and motivation despite initiation of escitalopram 3 months earlier. In addition, her infant had non-organic failure to thrive mediated by decreased feeding and non-initiation of solids. On admission, her cognitive difficulties, blurred vision and reported loss of smell led to further neurological assessment and investigation with an MRI. Diagnosis of a frontal meningioma was made on the basis of the MRI finding of a 7 cm meningioma in the anterior cranial fossa. Surgical removal was successful which led to resolution of her depressive symptoms and improved parenting functioning. This case highlights the importance of considering organic causes of depression and non-organic causes of failure to thrive in infants.
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Affiliation(s)
- Nevani Murgan
- Mother Baby Unit, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Beate Harrison
- Mother Baby Unit, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
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A systematic review and meta-analysis of the association between cyproterone acetate and intracranial meningiomas. Sci Rep 2022; 12:1942. [PMID: 35121790 PMCID: PMC8816922 DOI: 10.1038/s41598-022-05773-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/17/2022] [Indexed: 12/22/2022] Open
Abstract
The influence of exposure to hormonal treatments, particularly cyproterone acetate (CPA), has been posited to contribute to the growth of meningiomas. Given the widespread use of CPA, this systematic review and meta-analysis attempted to assess real-world evidence of the association between CPA and the occurrence of intracranial meningiomas. Systematic searches of Ovid MEDLINE, Embase and Cochrane Controlled Register of Controlled Trials, were performed from database inception to 18th December 2021. Four retrospective observational studies reporting 8,132,348 patients were included in the meta-analysis. There was a total of 165,988 subjects with usage of CPA. The age of patients at meningioma diagnosis was generally above 45 years in all studies. The dosage of CPA taken by the exposed group (n = 165,988) was specified in three of the four included studies. All studies that analyzed high versus low dose CPA found a significant association between high dose CPA usage and increased risk of meningioma. When high and low dose patients were grouped together, there was no statistically significant increase in risk of meningioma associated with use of CPA (RR = 3.78 [95% CI 0.31–46.39], p = 0.190). Usage of CPA is associated with increased risk of meningioma at high doses but not when low doses are also included. Routine screening and meningioma surveillance by brain MRI offered to patients prescribed with CPA is likely a reasonable clinical consideration if given at high doses for long periods of time. Our findings highlight the need for further research on this topic.
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Giraldi L, Lauridsen EK, Maier AD, Hansen JV, Broholm H, Fugleholm K, Scheie D, Munch TN. Pathologic Characteristics of Pregnancy-Related Meningiomas. Cancers (Basel) 2021; 13:cancers13153879. [PMID: 34359779 PMCID: PMC8345640 DOI: 10.3390/cancers13153879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Meningiomas are the most common primary intracranial tumor in adults. Meningiomas are usually benign and slow growing. Treatment is surgical resection in the case of symptomatic growth. Dramatic growth can occur during pregnancy, complicating clinical management and entailing a risk to the well-being of the mother and fetus. Authors of a previous review paper raised the hypothesis that prolactin may be a key contributor to the sudden growth seen in pregnancy-related meningiomas. We set out to investigate the presence of prolactin receptors/prolactin, as well as other female hormones and histopathological characteristics of pregnancy-related meningiomas in Denmark, compared to meningiomas from female controls within the same age group. No differences in hormone receptor distribution were found between the groups and very few meningiomas expressed prolactin receptors, which contradicts the above-mentioned hypothesis. Interestingly, we observed above cut-point proliferative indices of the meningiomas for the entire study population of females in the reproductive age. Abstract Meningiomas are the most common intracranial tumor. During pregnancy, explosive growth of a known meningioma occasionally occurs, but the underlying reasons remain unknown. Prolactin has been suggested as a possible key contributor to pregnancy-related meningioma growth. This study sets out to investigate prolactin and prolactin receptor status in 29 patients with pregnancy-related meningiomas in Denmark, from January 1972 to December 2016, as compared to 68 controls aged 20–45 years, also undergoing resection of a meningioma. Furthermore, we investigated potential differences in the progesterone and estrogen receptor statuses, WHO grade, Ki-67 labeling indices, and locations of the resected meningiomas between the cases and controls. Immunohistochemical analyses were performed, and histopathology and intracranial location were assessed with the investigator blinded for the case–control status. None of the samples stained positive for prolactin and very few samples stained positive for prolactin receptors, equally distributed among cases and controls. Estrogen and progesterone receptors generally followed the same distributional pattern between groups, whereas above cut-point Ki-67 labeling indices for both groups were observed. In conclusion, our results did not support the notion of prolactin as a key contributor to pregnancy-related meningioma growth. Rather, the similarities between the cases and controls suggest that meningiomas early in life may comprise a distinct biological entity.
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Affiliation(s)
- Laura Giraldi
- Department of Epidemiology Research, Statens Serum Institute, DK-2300 Copenhagen, Denmark; (L.G.); (J.V.H.)
| | - Emma Kofoed Lauridsen
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; (E.K.L.); (A.D.M.); (K.F.)
| | - Andrea Daniela Maier
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; (E.K.L.); (A.D.M.); (K.F.)
- Department of Pathology, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; (H.B.); (D.S.)
| | - Jørgen Vinsløv Hansen
- Department of Epidemiology Research, Statens Serum Institute, DK-2300 Copenhagen, Denmark; (L.G.); (J.V.H.)
| | - Helle Broholm
- Department of Pathology, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; (H.B.); (D.S.)
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; (E.K.L.); (A.D.M.); (K.F.)
| | - David Scheie
- Department of Pathology, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; (H.B.); (D.S.)
| | - Tina Nørgaard Munch
- Department of Epidemiology Research, Statens Serum Institute, DK-2300 Copenhagen, Denmark; (L.G.); (J.V.H.)
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark; (E.K.L.); (A.D.M.); (K.F.)
- Department of Clinical Medicine, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Correspondence:
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Maggio I, Franceschi E, Tosoni A, Nunno VD, Gatto L, Lodi R, Brandes AA. Meningioma: not always a benign tumor. A review of advances in the treatment of meningiomas. CNS Oncol 2021; 10:CNS72. [PMID: 34015955 PMCID: PMC8162186 DOI: 10.2217/cns-2021-0003] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022] Open
Abstract
Meningiomas are the most common primary intracranial tumors. The majority of meningiomas are benign, but they can present different grades of dedifferentiation from grade I to grade III (anaplastic/malignant) that are associated with different outcomes. Radiological surveillance is a valid option for low-grade asymptomatic meningiomas. In other cases, the treatment is usually surgical, aimed at achieving a complete resection. The use of adjuvant radiotherapy is the gold standard for grade III, is debated for grade II and is not generally indicated for radically resected grade I meningiomas. The use of systemic treatments is not standardized. Here we report a review of the literature on the clinical, radiological and molecular characteristics of meningiomas, available treatment strategies and ongoing clinical trials.
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Affiliation(s)
- Ilaria Maggio
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Enrico Franceschi
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Alicia Tosoni
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Vincenzo Di Nunno
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Lidia Gatto
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
| | - Raffaele Lodi
- IRCSS Istituto di Scienze Neurologiche di Bologna, Bologna 40139, Italy
| | - Alba A Brandes
- Medical Oncology Department, Azienda USL, Via Altura 3, 40139, Bologna, Italy
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Girardelli S, Albano L, Mangili G, Valsecchi L, Rabaiotti E, Cavoretto PI, Mortini P, Candiani M. Meningiomas in Gynecology and Reproduction: an Updated Overview for Clinical Practice. Reprod Sci 2021; 29:2452-2464. [PMID: 33970444 DOI: 10.1007/s43032-021-00606-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
There is various evidence to suggest a relationship between female hormones and meningiomas; as clinicians, we often come to face challenging situations involving female patients diagnosed with meningiomas during the post-pubertal phases of their life. We aimed to review the specific circumstances (pregnancy, postpartum, hormonal contraception and hormone replacement therapy, gender-affirming hormonal treatment) clinicians might come to face during their daily clinical practice, given the absence of available guidelines. We therefore conducted a narrative review on articles found in PubMed and Embase databases using appropriate keywords. Ninety-six relevant articles were included. The available evidence on managing meningiomas in post-pubertal women often implies personal strategies, highlighting the lack of a unified approach. The knowledge of the biological links between female hormones and meningiomas is fundamental to correctly counsel patients in various life phases. Prospective randomized studies are required to improve available guidelines on how to best manage meningiomas in female post-pubertal patients.
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Affiliation(s)
- Serena Girardelli
- Obstetrics and Gynecology Department, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Luigi Albano
- Neurosurgery and Radiosurgery Department, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Department, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Valsecchi
- Obstetrics and Gynecology Department, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Emanuela Rabaiotti
- Obstetrics and Gynecology Department, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Paolo Ivo Cavoretto
- Obstetrics and Gynecology Department, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Neurosurgery and Radiosurgery Department, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Department, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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The risk of developing a meningioma during and after pregnancy. Sci Rep 2021; 11:9153. [PMID: 33911184 PMCID: PMC8080659 DOI: 10.1038/s41598-021-88742-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/09/2021] [Indexed: 01/01/2023] Open
Abstract
Pregnancy has been associated with diagnosis or growth of meningiomas in several case reports, which has led to the hypothesis that pregnancy may be a risk factor for meningiomas. The aim of this study was to test this hypothesis in a large population-based cohort study. Women born in Sweden 1958–2000 (N = 2,204,126) were identified and matched with the Medical Birth Register and the Cancer Register. The expected number of meningioma cases and risk ratios were calculated for parous and nulliparous women and compared to the observed number of cases. Compared to parous women, meningiomas were more common among nulliparous (SIR = 1.73; 95% CI 1.52–1.95). The number of meningioma cases detected during pregnancy was lower than the expected (SIR = 0.40; 95% CI 0.20–0.72). Moreover, no increased risk was found in the first-year post-partum (SIR = 1.04; 95% CI 0.74–1.41). Contrary to our hypothesis, there was no increased risk for diagnosing a meningioma during pregnancy or 1-year post-partum. A lower detection rate during pregnancy, may reflect under-utilization of diagnostic procedures, but the actual number of meningiomas was homogenously lower among parous than nulliparous women throughout the study period, indicating that pregnancy is not a risk factor for meningioma.
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Weill A, Nguyen P, Labidi M, Cadier B, Passeri T, Duranteau L, Bernat AL, Yoldjian I, Fontanel S, Froelich S, Coste J. Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study. BMJ 2021; 372:n37. [PMID: 33536184 DOI: 10.1136/bmj.n37] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the risk of meningioma associated with use of high dose cyproterone acetate, a progestogen indicated for clinical hyperandrogenism. DESIGN Observational cohort study. SETTING Data from SNDS, the French administrative healthcare database, between 2007 and 2015. PARTICIPANTS 253 777 girls and women aged 7-70 years living in France who started cyproterone acetate between 2007 and 2014. Participants had at least one reimbursement for high dose cyproterone acetate and no history of meningioma or benign brain tumour, or long term disease status. Participants were considered to be exposed when they had received a cumulative dose of at least 3 g during the first six months (139 222 participants) and very slightly exposed (control group) when they had received a cumulative dose of less than 3 g (114 555 participants). 10 876 transgender participants (male to female) were included in an additional analysis. MAIN OUTCOME MEASURE Surgery (resection or decompression) or radiotherapy for one or more intracranial meningiomas. RESULTS Overall, 69 meningiomas in the exposed group (during 289 544 person years of follow-up) and 20 meningiomas in the control group (during 439 949 person years of follow-up) were treated by surgery or radiotherapy. The incidence of meningioma in the two groups was 23.8 and 4.5 per 100 000 person years, respectively (crude relative risk 5.2, 95% confidence interval 3.2 to 8.6; adjusted hazard ratio 6.6, 95% confidence interval 4.0 to 11.1). The adjusted hazard ratio for a cumulative dose of cyproterone acetate of more than 60 g was 21.7 (10.8 to 43.5). After discontinuation of cyproterone acetate for one year, the risk of meningioma in the exposed group was 1.8-fold higher (1.0 to 3.2) than in the control group. In a complementary analysis, 463 women with meningioma were observed among 123 997 already using cyproterone acetate in 2006 (risk of 383 per 100 000 person years in the group with the highest exposure in terms of cumulative dose). Meningiomas located in the anterior skull base and middle skull base, particularly the medial third of the middle skull base, involving the spheno-orbital region, appeared to be specific to cyproterone acetate. An additional analysis of transgender participants showed a high risk of meningioma (three per 14 460 person years; 20.7 per 100 000 person years). CONCLUSIONS A strong dose-effect relation was observed between use of cyproterone acetate and risk of intracranial meningiomas. A noticeable reduction in risk was observed after discontinuation of treatment.
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Affiliation(s)
- Alain Weill
- Department of Public Health Studies, French National Health Insurance, Paris, France
- EPI-PHARE Scientific Interest Group, Saint-Denis, France
| | - Pierre Nguyen
- EPI-PHARE Scientific Interest Group, Saint-Denis, France
- French National Agency for the Safety of Medicines and Health Products (ANSM), Saint-Denis, France
| | - Moujahed Labidi
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Benjamin Cadier
- Department of Public Health Studies, French National Health Insurance, Paris, France
| | - Thibault Passeri
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Lise Duranteau
- Gynaecology Unit and Reference Center for Rare Diseases of Genital Development, AP-HP, University Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Isabelle Yoldjian
- French National Agency for the Safety of Medicines and Health Products (ANSM), Saint-Denis, France
| | | | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, University of Paris, Paris, France
| | - Joël Coste
- Department of Public Health Studies, French National Health Insurance, Paris, France
- Biostatistics and Epidemiology Unit, Cochin Hospital, AP-HP, Paris, France
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Yang X, Liu F, Zheng J, Cheng W, Zhao C, Di J. Relationship Between Oral Contraceptives and the Risk of Gliomas and Meningiomas: A Dose-Response Meta-Analysis and Systematic Review. World Neurosurg 2020; 147:e148-e162. [PMID: 33307268 DOI: 10.1016/j.wneu.2020.11.175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Glioma and meningioma are the most common primary brain tumors in adults. Epidemiologic studies of the relationship between female hormone exposure and exogenous hormone use and the risk of meningioma and glioma in females have yielded inconsistent results. METHODS Two investigators comprehensively searched 3 electronic databases, including PubMed, Embase, and Cochrane Library. A total of 11 case-control studies were enrolled for meta-analysis. Dose-response meta-analyses were conducted. RESULTS Compared with the non-oral contraceptives (OCs) female users, the female OC users might have reduced risk of glioma (risk ratio [RR], 0.87; 95% confidence interval [CI], 0.77-0.97; I2 = 42.6%). However, there was no obvious evidence of an association between OC use and the risk of meningioma in females (RR, 0.99; 95% CI, 0.87-1.13; I2 = 42.7%). Using OCs for >10 years in females may significantly decrease the risk of glioma to 30% (RR, 0.7; 95% CI, 0.6-0.81; I2 = 0%). The dose-response meta-analyses indicated that the risk of glioma in females significantly decreased when the duration of oral OC use was >7.5 years. CONCLUSIONS OC use may not increase the risks of glioma and meningioma in females. Instead, the long-term use of OCs may significantly decrease the risk of glioma, and the benefits are even more pronounced when the time window is >7.5 years. Nonetheless, the pooled results in this study suggest that OC use may not increase the risk of meningioma. Therefore, our conclusion should be validated and supplemented in future larger studies.
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Affiliation(s)
- Xin Yang
- Department of Oncology, Affiliated Hospital of Qinghai University, Xining, China
| | - Feng Liu
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Jiawei Zheng
- Department of Cardiology, Shenzhen Nanshan Hospital, Shenzhen, China
| | - Wenke Cheng
- Department of Cardiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Chao Zhao
- Department of Neurosurgery, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Ji Di
- Department of Oncology, Affiliated Hospital of Qinghai University, Xining, China.
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Asad AS, Nicola Candia AJ, Gonzalez N, Zuccato CF, Seilicovich A, Candolfi M. The role of the prolactin receptor pathway in the pathogenesis of glioblastoma: what do we know so far? Expert Opin Ther Targets 2020; 24:1121-1133. [PMID: 32896197 DOI: 10.1080/14728222.2020.1821187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Prolactin (PRL) and its receptor (PRLR) have been associated with the development of hormone-dependent tumors and have been detected in glioblastoma (GBM) biopsies. GBM is the most common and aggressive primary brain tumor in adults and the prognosis for patients is dismal; hence researchers are exploring the PRLR pathway as a therapeutic target in this disease. Areas covered: This paper explores the effects of PRLR activation on the biology of GBM, the correlation between PRL and PRLR expression and GBM progression and survival in male and female patients. Finally, we discuss how a better understanding of the PRLR pathway may allow the development of novel treatments for GBM. Expert opinion: We propose PRL and PRLR as potential prognosis biomarkers and therapeutic targets in GBM. Local administration of PRLR inhibitors using gene therapy may offer a beneficial strategy for targeting GBM cells disseminated in the non-neoplastic brain; however, efficacy and safety require careful and extensive evaluation. The data depicted herein underline the need to (i) improve our understanding of sexual dimorphism in GBM, and (ii) develop accurate preclinical models that take into consideration different hormonal contexts, specific genetic alterations, and tumor grades.
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Affiliation(s)
- Antonela S Asad
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires , Buenos Aires, Argentina
| | - Alejandro J Nicola Candia
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires , Buenos Aires, Argentina
| | - Nazareno Gonzalez
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires , Buenos Aires, Argentina
| | - Camila F Zuccato
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires , Buenos Aires, Argentina
| | - Adriana Seilicovich
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires , Buenos Aires, Argentina.,departamento de Biología Celular e Histología, Facultad de Medicina, Universidad de Buenos Aires , Buenos Aires, Argentina
| | - Marianela Candolfi
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires , Buenos Aires, Argentina
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Eckenstein M, Thomas AA. Benign and malignant tumors of the central nervous system and pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:241-258. [PMID: 32768091 DOI: 10.1016/b978-0-444-64240-0.00014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tumors of the central nervous system (CNS) are rare entities, typically affecting the very young or the very old, but span a spectrum of disease that may present in any age group. Women of reproductive age are more likely to be affected by benign tumors, including pituitary adenomas and meningiomas, and aggressive intracranial malignancies, such as brain metastases and glioblastoma, rarely present in pregnancy. Definitive management of CNS tumors may involve multimodal therapy, including surgery, radiation, and chemotherapy, and each of these treatments carries risk to the mother and developing fetus. CNS tumors often present with challenging and morbid symptoms such as headache and seizure, which need to be managed throughout a pregnancy. Decisions about timing treatment during pregnancy or delaying until after delivery, continuing or electively terminating a pregnancy, and future family planning and fertility are complex and require a multidisciplinary care team to evaluate the implications to both mother and baby. There are no guidelines or consensus recommendations regarding brain tumor management in pregnancy, and thus, individual treatment decisions are made by the care team based on experiential evidence, extrapolation of guidelines for nonpregnant patients, and patient values and preferences.
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Affiliation(s)
- Midori Eckenstein
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Alissa A Thomas
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States.
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20
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Asad AS, Nicola Candia AJ, Gonzalez N, Zuccato CF, Abt A, Orrillo SJ, Lastra Y, De Simone E, Boutillon F, Goffin V, Seilicovich A, Pisera DA, Ferraris MJ, Candolfi M. Prolactin and its receptor as therapeutic targets in glioblastoma multiforme. Sci Rep 2019; 9:19578. [PMID: 31862900 PMCID: PMC6925187 DOI: 10.1038/s41598-019-55860-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022] Open
Abstract
Although prolactin (PRL) and its receptor (PRLR) have been detected in glioblastoma multiforme (GBM), their role in its pathogenesis remains unclear. Our aim was to explore their contribution in GBM pathogenesis. We detected PRL and PRLR in all GBM cell lines tested. PRLR activation or overexpression using plasmid transfection increased proliferation, viability, clonogenicity, chemoresistance and matrix metalloproteinase activity in GBM cells, while PRLR antagonist ∆1–9-G129R-hPRL reduced their proliferation, viability, chemoresistance and migration. Meta-analysis of transcriptomic data indicated that PRLR was expressed in all grade II-III glioma (GII-III) and GBM samples. PRL was upregulated in GBM biopsies when compared to GII-III. While in the general population tumour PRL/PRLR expression did not correlate with patient survival, biological sex-stratified analyses revealed that male patients with PRL+/PRLRHIGH GBM performed worse than PRL+/PRLRLOW GBM. In contrast, all male PRL+/PRLRHIGH GII-III patients were alive whereas only 30% of PRL+/PRLRLOW GII-III patients survived after 100 months. Our study suggests that PRLR may be involved in GBM pathogenesis and could constitute a therapeutic target for its treatment. Our findings also support the notion that sexual dimorphism should be taken into account to improve the care of GBM patients.
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Affiliation(s)
- Antonela Sofía Asad
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Javier Nicola Candia
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nazareno Gonzalez
- Max Planck Laboratory for Structural Biology, Chemistry and Molecular Biophysics of Rosario (MPLbioR), Universidad Nacional de Rosario, Rosario, Argentina
| | - Camila Florencia Zuccato
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Araceli Abt
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Jordi Orrillo
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Yael Lastra
- Cátedra de Fisiología Animal, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Emilio De Simone
- Cátedra de Fisiología Animal, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Florence Boutillon
- Inserm U1151, Institut Necker Enfants Malades (INEM), Faculty of Medicine, University Paris Descartes, Paris, France
| | - Vincent Goffin
- Inserm U1151, Institut Necker Enfants Malades (INEM), Faculty of Medicine, University Paris Descartes, Paris, France
| | - Adriana Seilicovich
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.,Departamento de Biología Celular e Histología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Alberto Pisera
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - María Jimena Ferraris
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marianela Candolfi
- Instituto de Investigaciones Biomédicas (INBIOMED, UBA-CONICET), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
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Mehta K, Atak A, Sahu A, Srivastava S, C MK. An early investigative serum Raman spectroscopy study of meningioma. Analyst 2019; 143:1916-1923. [PMID: 29620771 DOI: 10.1039/c8an00224j] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Meningiomas represent one of the most frequently reported non-glial, primary brain and central nervous system (CNS) tumors. Meningiomas often display a spectrum of anomalous locations and morphological attributes, deterring their timely diagnosis. Majority of them are sporadic in nature and thus the present-day screening strategies, including radiological investigations, often result in misdiagnosis due to their aberrant and equivocal radiological facets. Therefore, it is pertinent to explore less invasive and patient-friendly biofluids such as serum for their screening and diagnostics. The utility of serum Raman spectroscopy in diagnosis and therapeutic monitoring of cancers has been reported in the literature. In the present study, for the first time, to the best of our knowledge, we have explored Raman spectroscopy to classify the sera of meningioma and control subjects. For this exploration, 35 samples each of meningioma and control subjects were accrued and the spectra revealed variance in the levels of DNA, proteins, lipids, amino acids and β-carotene, i.e., a relatively higher protein, DNA and lipid content in meningioma. Subsequent Principal Component Analysis (PCA) and Principal Component-Linear Discriminant Analysis (PC-LDA) followed by Leave-One-Out Cross-Validation (LOOCV) and limited independent test data, in a patient-wise approach, yielded a classification efficiency of 92% and 80% for healthy and meningioma, respectively. Additionally, in the analogous analysis between healthy and different grades of meningioma, similar results were obtained. These results indicate the potential of Raman spectroscopy in differentiating meningioma. As present methods suffer from known limitations, with the prospective validation on a larger cohort, serum Raman spectroscopy could be an adjuvant/alternative approach in the clinical management of meningioma.
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Affiliation(s)
- Kanika Mehta
- Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai-400076, India.
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Nigim F, Wakimoto H, Kasper EM, Ackermans L, Temel Y. Emerging Medical Treatments for Meningioma in the Molecular Era. Biomedicines 2018; 6:biomedicines6030086. [PMID: 30082628 PMCID: PMC6165537 DOI: 10.3390/biomedicines6030086] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 12/19/2022] Open
Abstract
Meningiomas are the most common type of primary central nervous system tumors. Approximately, 80% of meningiomas are classified by the World Health Organization (WHO) as grade I, and 20% of these tumors are grade II and III, considered high-grade meningiomas (HGMs). Clinical control of HGMs, as well as meningiomas that relapse after surgery, and radiation therapy is difficult, and novel therapeutic approaches are necessary. However, traditional chemotherapies, interferons, hormonal therapies, and other targeted therapies have so far failed to provide clinical benefit. During the last several years, next generation sequencing has dissected the genetic heterogeneity of meningioma and enriched our knowledge about distinct oncogenic pathways driving different subtypes of meningiomas, opening up a door to new personalized targeted therapies. Molecular classification of meningioma allows a new design of clinical trials that assign patients to corresponding targeted agents based on the tumor genetic subtypes. In this review, we will shed light on emerging medical treatments of meningiomas with a particular focus on the new targets identified with genomic sequencing that have led to clinical trials testing novel compounds. Moreover, we present recent development of patient-derived preclinical models that provide platforms for assessing targeted therapies as well as strategies with novel mechanism of action such as oncolytic viruses.
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Affiliation(s)
- Fares Nigim
- Brain Tumor Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Hiroaki Wakimoto
- Brain Tumor Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Ekkehard M Kasper
- Department of Neurosurgery, McMaster University, Hamilton, ON 8L8 2X2, Canada.
| | - Linda Ackermans
- Department of Neurosurgery and Neuroscience, Maastricht University Medical Center, 6229 HY Maastricht, The Netherlands.
| | - Yasin Temel
- Department of Neurosurgery and Neuroscience, Maastricht University Medical Center, 6229 HY Maastricht, The Netherlands.
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Altinoz MA, Nalbantoglu J, Ozpinar A, Emin Ozcan M, Del Maestro RF, Elmaci I. From epidemiology and neurodevelopment to antineoplasticity. Medroxyprogesterone reduces human glial tumor growth in vitro and C6 glioma in rat brain in vivo. Clin Neurol Neurosurg 2018; 173:20-30. [PMID: 30055402 DOI: 10.1016/j.clineuro.2018.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Glial tumor growth may accelerate during gestation, but epidemiological studies consistently demonstrated that parousity reduces life long risk of glial tumors. Pregnancy may also accelerate growth of medulloblastoma and meningioma, but parousity does not confer protection against these tumors. We were the first to show that medroxyprogesterone acetate (MPA) reduces rat C6 glioma growth in vitro. Now we aimed to determine the effects of MPA on human brain cancers (particularly glioblastoma) in vitro and C6 glioma in vivo. PATIENTS AND METHODS We evaluated the effects of MPA on: i) monolayer growth of human U87 and U251 glioblastoma, ii) 3D-spheroid growth and invasion of C6 rat glioma and human U251 glioma, iii) interactions with PI3-Kinase inhibitors and coxsackie-adenovirus receptor (CAR) in modifying 3D-spheroid invasion of glioma. RESULTS MPA at low doses (3.25-13 μM) insignificantly stimulated and at high doses (above 52 μM) strongly suppressed the growth of human U87 and U251 cells in vitro. MPA also binds to glucocorticoid receptors similar to dexamethasone (Dex) and unexpectedly, PI3-Kinase inhibitors at low doses suppressed anti-invasive efficacies of MPA and Dex. MPA exerted higher invasion-inhibitory effects on CAR-expressing human glioma cells. Lastly, MPA suppressed growth of C6 glioma implanted into rat brain. CONCLUSION Progesterone analogues deserve to be studied in future experimental models of high grade glial brain tumors.
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Affiliation(s)
- Meric A Altinoz
- Neuroacademy Research Group, Istanbul, Turkey; Department of Psychiatry, Maastricht University, Holland, Netherlands.
| | - Josephine Nalbantoglu
- Department of Neuroimmunology, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Aysel Ozpinar
- Department of Medical Biochemistry, Acibadem University, Istanbul, Turkey
| | - M Emin Ozcan
- Department of Neurology, Kizilay Hospital, Bakirkoy, Istanbul, Turkey
| | | | - Ilhan Elmaci
- Neuroacademy Research Group, Istanbul, Turkey; Department of Neurosurgery, Memorial Hospital, Istanbul, Turkey
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Broestl L, Rubin JB, Dahiya S. Fetal microchimerism in human brain tumors. Brain Pathol 2018; 28:484-494. [PMID: 28921714 PMCID: PMC5884742 DOI: 10.1111/bpa.12557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 09/13/2017] [Indexed: 11/26/2022] Open
Abstract
Sex differences in cancer incidence and survival, including central nervous system tumors, are well documented. Multiple mechanisms contribute to sex differences in health and disease. Recently, the presence of fetal-in-maternal microchimeric cells has been shown to have prognostic significance in breast and colorectal cancers. The frequency and potential role of these cells has not been investigated in brain tumors. We therefore selected two common primary adult brain tumors for this purpose: meningioma, which is sex hormone responsive and has a higher incidence in women, and glioblastoma, which is sex hormone independent and occurs more commonly in men. Quantitative PCR was used to detect the presence of male DNA in tumor samples from women with a positive history of male pregnancy and a diagnosis of either glioblastoma or meningioma. Fluorescence in situ hybridization for the X and Y chromosomes was used to verify the existence of intact male cells within tumor tissue. Fetal microchimerism was found in approximately 80% of glioblastoma cases and 50% of meningioma cases. No correlations were identified between the presence of microchimerism and commonly used clinical or molecular diagnostic features of disease. The impact of fetal microchimeric cells should be evaluated prospectively.
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Affiliation(s)
- Lauren Broestl
- Department of PediatricsWashington University School of MedicineSt. LouisMO
| | - Joshua B. Rubin
- Department of PediatricsWashington University School of MedicineSt. LouisMO
- Department of NeuroscienceWashington University School of MedicineSt. LouisMO
| | - Sonika Dahiya
- Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisMO
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Houdini Tumor: Case Report and Literature Review of Pregnancy-Associated Meningioma. World Neurosurg 2018; 114:e1261-e1265. [DOI: 10.1016/j.wneu.2018.03.187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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26
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Mancini I, Rotilio A, Coati I, Seracchioli R, Martelli V, Meriggiola MC. Presentation of a meningioma in a transwoman after nine years of cyproterone acetate and estradiol intake: case report and literature review. Gynecol Endocrinol 2018; 34:456-459. [PMID: 29105524 DOI: 10.1080/09513590.2017.1395839] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The administration of cyproterone acetate (CPA) and estradiol is a common regimen used by male-to-female transsexuals (transwoman) to adjust their body to their gender identity. Major adverse events are uncommon in these subjects in spite of long-term, high dose cross-sex steroid treatments. We describe the occurrence of a meningioma in a transwoman treated with estrogens and CPA over a period of nine years. The meningioma was revealed during a magnetic resonance imaging (MRI) scan performed as follow-up of a previous surgery for ganglioglioma. CPA intake was discontinued and tumor resection was performed. Histological diagnosis confirmed a strong progesterone receptor-positive and slight estrogen positive meningioma. After surgery, the patient continued her treatment with leuprorelina acetate and estradiol. At one-year follow-up, the MRI scan reveals no recurrence of the tumor. This is the ninth case in literature of a meningioma in a transwoman treated with estrogens and CPA, confirming a possible association between female sex steroids and meningioma. Although there is no still strong evidence of an association between meningioma and CPA, this report may suggest use of alternative treatment for transwomen. This report highlights the importance to record all the cases of meningiomas in high dose CPA-users, in order to improve data.
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Affiliation(s)
| | - Antonino Rotilio
- b Department of Surgery , Operative Unit of Neurosurgery, Hospital of Padua , Padua , Italy
| | - Irene Coati
- c Department of Medicine (DIMED) , Surgical Pathology Unit, University of Padua , Padua , Italy
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Cardia A, Zerbetto I, Cannizzaro D, Picozzi P, Fornari M, Levi Setti P, Servadei F. In-vitro fertilization and hormone-dependent brain tumors: could the new era of in-vitro fertilization and social freezing change our incidentally discovered brain tumor management? J Neurosurg Sci 2018; 64:213-214. [PMID: 29808634 DOI: 10.23736/s0390-5616.18.04469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrea Cardia
- Department of Neurosurgery, Humanitas Clinical Research Hospital, Neurocenter, Rozzano, Milan, Italy
| | - Irene Zerbetto
- Humanitas Fertility Center, Division of Gynaecology and Reproductive Medicine, Department of Gynecology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Delia Cannizzaro
- Department of Neurosurgery, Humanitas Clinical Research Hospital, Neurocenter, Rozzano, Milan, Italy -
| | - Piero Picozzi
- Department of Neurosurgery, Humanitas Clinical Research Hospital, Neurocenter, Rozzano, Milan, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, Humanitas Clinical Research Hospital, Neurocenter, Rozzano, Milan, Italy
| | - Paolo Levi Setti
- Humanitas Fertility Center, Division of Gynaecology and Reproductive Medicine, Department of Gynecology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Franco Servadei
- Department of Neurosurgery, Humanitas Clinical Research Hospital, Neurocenter, Rozzano, Milan, Italy
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Casabella AM, Urakov TM, Basil G, Morcos JJ. Management of Foramen Magnum Meningioma During Pregnancy: Literature Review and Case Report. World Neurosurg 2017; 97:752.e15-752.e18. [DOI: 10.1016/j.wneu.2016.10.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022]
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Quach P, El Sherif R, Gomes J, Krewksi D. A systematic review of the risk factors associated with the onset and progression of primary brain tumours. Neurotoxicology 2016; 61:214-232. [PMID: 27212451 DOI: 10.1016/j.neuro.2016.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 12/17/2022]
Abstract
The overall aim of this systematic review was to identify risk factors for onset and natural progression, which were shown to increase, decrease, or have a null association with risk of primary brain tumour. For onset, the project was separated into two phases. The first phase consisted of a systematic search of existing systematic reviews and meta-analyses. Moderate to high methodological quality reviews were incorporated and summarized with relevant observational studies published since 2010, identified from a systematic search performed in phase 2. For natural progression, only the first phase was conducted. Standard systematic review methodology was utilized. Based on this review, various genetic variants, pesticide exposures, occupational farming/hairdressing, cured meat consumption and personal hair dye use appear to be associated with increased risk of onset amongst adults. The specific EGF polymorphsm 61-A allele within Caucasian populations and having a history of allergy was associated with a decreased risk. For progression, M1B-1 antigen was shown to increase the risk. High birth weight, pesticide exposure (childhood exposure, and parental occupational exposure) and maternal consumption of cured meat during pregnancy may also increase the risk of onset of childhood brain tumours. Conversely, maternal intake of pre-natal supplements (folic acid) appeared to decrease risk. Children with neurofibromatosis 2 were considered to have worse overall and relapse free survival compared to neurofibromatosis 1, as were those children who had grade III tumours compared to lesser grades.
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Affiliation(s)
- Pauline Quach
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Reem El Sherif
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - James Gomes
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Canada
| | - Daniel Krewksi
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada; McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Risk Sciences International, Ottawa, ON, Canada
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Ji J, Sundquist J, Sundquist K. Association of tamoxifen with meningioma: a population-based study in Sweden. Eur J Cancer Prev 2016; 25:29-33. [PMID: 25642792 PMCID: PMC4885544 DOI: 10.1097/cej.0000000000000133] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022]
Abstract
Previous studies suggest that hormone therapy may play an important role in the development of meningioma. However, it is unclear whether medication with tamoxifen can prevent meningioma. Our study cohort included all women who were diagnosed with breast cancer between 1961 and 2010, and a total of 227 535 women were identified with breast cancer with a median age at diagnosis of 63 years. Women diagnosed with breast cancer after 1987 were defined as tamoxifen exposed; those diagnosed with breast cancer before or during 1987 were defined as not exposed to tamoxifen. Standardized incidence ratios (SIRs) were used to calculate the risk of subsequent meningioma. Of these women, 223 developed meningioma. For women without tamoxifen exposure, the risk of meningioma was significantly increased, with an SIR of 1.54 (95% confidence interval 1.30-1.81); the risk was not increased in those with tamoxifen exposure (SIR=1.06, 95% confidence interval 0.84-1.32). The increased risk of meningioma in women without tamoxifen exposure persisted during 10 years of follow-up. In this historical cohort study, we found that women diagnosed with breast cancer but not treated with tamoxifen had an increased incidence of meningioma, whereas the incidence was close to that of the general population in patients treated with tamoxifen. This suggests that tamoxifen may prevent the development of meningioma.
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Affiliation(s)
- Jianguang Ji
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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31
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Kerschbaumer J, Freyschlag CF, Stockhammer G, Taucher S, Maier H, Thomé C, Seiz-Rosenhagen M. Hormone-dependent shrinkage of a sphenoid wing meningioma after pregnancy: case report. J Neurosurg 2016; 124:137-40. [DOI: 10.3171/2014.12.jns142112] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meningiomas are known to be associated with female sex hormones. Worsening neurological symptoms or newly diagnosed meningiomas have been described in the context of elevated levels of sex hormones, for example, in pregnancy. To the authors’ knowledge, tumor shrinkage after the normalization of hormones has not been described, even if it is known that neurological deficits due to meningioma compression may improve after giving birth.
A 32-year-old female patient presented with severe headache and vision disturbances at the end of her second pregnancy. Magnetic resonance imaging revealed an extended mass at the lateral left-sided sphenoid wing that was suspected to be a meningioma. After delivery, the patient’s symptoms improved, and MRI obtained 2 months postpartum showed significant shrinkage of the lesion.
Significant tumor shrinkage can occur after pregnancy. Thus, repeat imaging is indicated in these patients.
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Affiliation(s)
| | | | | | | | - Hans Maier
- 4Pathology, Medical University of Innsbruck, Austria
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32
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Reigstad MM, Larsen IK, Myklebust TÅ, Robsahm TE, Oldereid NB, Omland AK, Vangen S, Brinton LA, Storeng R. Cancer risk among parous women following assisted reproductive technology. Hum Reprod 2015; 30:1952-63. [PMID: 26113657 PMCID: PMC4507330 DOI: 10.1093/humrep/dev124] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/08/2015] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Do women who give birth after assisted reproductive technology (ART) have an increased risk of cancer compared with women who give birth without ART? SUMMARY ANSWER Without correction, the results indicate an increase in overall cancer risk, as well as a 50% increase in risk of CNS cancer for women giving birth after ART, however the results were not significant after correcting for multiple analyses. WHAT IS KNOWN ALREADY Studies regarding the effects of hormonal treatments involved with ART on subsequent cancer risk have provided inconsistent results, and it has also been suggested that infertility itself could be a contributory factor. STUDY DESIGN, SIZE, DURATION A population-based cohort consisting of all women registered in the Medical Birth Registry of Norway as having given birth between 1 January 1984 and 31 December 2010 was assembled (n = 812 986). Cancers were identified by linkage to the Cancer Registry of Norway. Study subjects were followed from start of first pregnancy during the observational period until the first cancer, death, emigration, or 31 December 2010. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the total study population (n = 806 248), 16 525 gave birth to a child following ART. Cox regression analysis computed hazard ratios (HR) and 95% confidence intervals (CI) comparing cancer risk between ART women and non-ART women; for overall cancer, and for cervical, ovarian, uterine, central nervous system (CNS), colorectal and thyroid cancers, and for malignant melanoma. MAIN RESULTS AND THE ROLE OF CHANCE A total of 22 282 cohort members were diagnosed with cancer, of which 338 were ART women and 21 944 non-ART women. The results showed an elevated risk in one out of seven sites for ART women. The HR for cancer of the CNS was 1.50 (95% CI 1.03- 2.18), and among those specifically subjected to IVF (without ICSI) the HR was 1.83 (95% CI 1.22-2.73). Analysis of risk of overall cancer gave an HR of 1.16 (95% CI 1.04-1.29). Among those who had delivered only one child by the end of follow-up, the HR for ovarian cancer was 2.00 (95% CI 1.08-3.65), and for those nulliparous at entry the HR was 1.80 (95% CI 1.04-3.11). However, all findings became non-significant after correcting for multiple analyses. LIMITATIONS, REASONS FOR CAUTION The results of elevated risk of overall cancer and CNS cancer lost significance when adjusting for multiple analyses, implying an important limitation of the study. The follow-up time was relatively short, especially for ART women. In addition, as the cohort was relatively young, there were few incident cancers, especially for some rarer cancer forms, such as uterine cancer. Risk assessments according to different causes of infertility could not be done. WIDER IMPLICATIONS OF THE FINDINGS In light of the findings in the present study, further studies should be made on risk of CNS and ovarian cancer, and continued monitoring of all those treated with ART is encouraged. Our findings may only be generalizable to women who give birth after ART, and the risk for women who remain nulliparous after ART remains to be assessed. STUDY FUNDING/COMPETING INTEREST The study was funded by the Norwegian National Advisory Unit on Women's Health. All authors claim no competing interests.
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Affiliation(s)
- M M Reigstad
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway Institute of Population-based Cancer Research, Cancer Registry of Norway, Oslo, Norway
| | - I K Larsen
- Institute of Population-based Cancer Research, Cancer Registry of Norway, Oslo, Norway
| | - T Å Myklebust
- Institute of Population-based Cancer Research, Cancer Registry of Norway, Oslo, Norway
| | - T E Robsahm
- Institute of Population-based Cancer Research, Cancer Registry of Norway, Oslo, Norway
| | - N B Oldereid
- Section of Reproductive Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - A K Omland
- Section of Reproductive Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - S Vangen
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - L A Brinton
- Division of Cancer Epidemiology & Genetics, Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - R Storeng
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Huang S, Chen X, Ke Z, Chen J. Comment on Zong et al.: "Reproductive factors in relation to risk of brain tumors in women: an updated meta-analysis of 27 independent studies". Tumour Biol 2015; 36:2209-10. [PMID: 25649978 DOI: 10.1007/s13277-015-3145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022] Open
Affiliation(s)
- Songshu Huang
- Department of 0Neurosurgery, The Shishi Hospital, Quanzhou, 362000, Fujian Province, China
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Owens MA, Craig BM, Egan KM, Reed DR. Birth desires and intentions of women diagnosed with a meningioma. J Neurosurg 2015; 122:1151-6. [PMID: 25623387 DOI: 10.3171/2014.11.jns14522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECT To the authors' knowledge, no previous study has examined the impact of meningioma diagnosis on women's birth desires and intentions. In an exploratory study, the authors surveyed women affected by meningioma to determine their attitudes toward childbearing and the influences, including physician recommendations, on this major life decision and compared their responses to those of women in the general population. METHODS Meningioma survivors from the Meningioma Mommas online support group participated in an online survey that included questions on their birth desires and intentions, whether the risk of disease recurrence influenced their reproductive decisions, and risks communicated to them by their physicians. Using chi-square and rank-sum tests, the authors compared the survey participants' responses with those of the general population as assessed by the 2006-2010 National Survey of Family Growth. Logistic regression was used to adjust for differences in age, race, ethnicity, education, parity, pregnancy status, and infertility status in these populations. RESULTS Respondents with meningioma were more likely than those in the general population to report wanting a baby (70% vs 54%, respectively), intending to have a baby (27% vs 12%, respectively), and being very sure about this intention (10% vs 2%, respectively). More than half (32 of 61) of the women of childbearing age reported being advised by a physician about potential risk factors for recurrence of the meningioma, and pregnancy was the most commonly cited risk factor (26 of 61). The most common factor influencing birth desires and intentions was risk of the meningioma returning and requiring more treatment, which was reported by nearly two-thirds of the women in their childbearing years. CONCLUSIONS A majority of the meningioma survivors of childbearing age who completed the survey reported a desire for children, although concern about the risk of meningioma recurrence was an important factor for these women when making reproductive decisions. Physicians are in a position to educate their patients on potential risk factors for recurrence and to provide contact information for services such as counseling and family planning.
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Impact of maternal brain tumours on perinatal and maternal management and outcome: a single referral centre retrospective study. Eur J Obstet Gynecol Reprod Biol 2014; 183:132-6. [DOI: 10.1016/j.ejogrb.2014.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 10/15/2014] [Accepted: 10/22/2014] [Indexed: 11/23/2022]
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Successful treatment of multiple intracranial meningiomas with the antiprogesterone receptor agent mifepristone (RU486). Acta Neurochir (Wien) 2014; 156:1831-5. [PMID: 25078073 DOI: 10.1007/s00701-014-2188-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/15/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meningiomas are the most frequent primary brain tumor in adults. Evidence suggests that female sex hormones play a role in the meningioma tumorigenesis. In particular, progesterone, has a receptor (PR) that is highly expressed in the majority of grade I meningiomas. Multiple meningiomas (diffuse meningiomatosis) are less frequent, but have a higher female predominance and a higher PR expression. They are, therefore, attractive candidates for anti-PR therapy. METHODS We treated three consecutive women with multiple meningiomas with mifepristone (RU 486). It is a synthetic steroid with high affinity for both progesterone and glucocorticoid receptors. RESULTS The treatment was well tolerated, and we observed an important and long-lasting clinical (3/3) and radiological response (2/3) or stabilisation. All the three patients are now stable after five to nine years of treatment. CONCLUSIONS These encouraging results strongly support a prospective clinical trial in this preselected population.
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Reproductive factors in relation to risk of brain tumors in women: an updated meta-analysis of 27 independent studies. Tumour Biol 2014; 35:11579-86. [PMID: 25135427 DOI: 10.1007/s13277-014-2448-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/04/2014] [Indexed: 12/25/2022] Open
Abstract
Previous studies on the association between reproductive factors and brain tumor risk in women have provided inconclusive findings. Thus, an updated meta-analysis was performed to obtain more precise risk estimates for brain tumor regarding several common reproductive factors. A comprehensive literature search for relevant publications in the PubMed and Embase databases was carried out from their inception up to June 20, 2014. Pooled relative risks (RRs) with corresponding 95% confidence intervals (CIs) were calculated. There were 27 independent studies with a total of 12,129 cases and 1,433,915 controls included into the present meta-analysis. We found that an elevated risk of brain tumors (RR=1.17, 95% CI 1.06-1.29, P=0.002), particularly glioma (RR=1.33, 95% CI 1.15-1.54, P<0.001), was related to older age at menarche. Interestingly, stratified analysis by type of brain tumors showed that the longer duration of breast feeding was associated with the risk of meningioma negatively but glioma positively (for meningioma: RR=0.76, 95% CI 0.64-0.91, P=0.002; for glioma: RR=1.70, 95% CI 1.14-2.55, P=0.010). No significant association was observed when estimating the roles of other reproductive factors including parity, age at first birth, menopausal status, and age at menopause in brain tumorigenesis. Our study suggests that older age at menarche is a risk factor of brain tumors and glioma in particular. Additionally, more studies are warranted to further elucidate roles and mechanisms of common reproductive factors in the risk of brain tumors.
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Imanieh MH, Bagheri F, Alizadeh AM, Ashkani-Esfahani S. Oxytocin has therapeutic effects on cancer, a hypothesis. Eur J Pharmacol 2014; 741:112-23. [PMID: 25094035 DOI: 10.1016/j.ejphar.2014.07.053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 01/25/2023]
Abstract
Oxytocin (OT) is the first peptide hormone structurally assessed and chemically synthesized in biologically active form. This hormone acts as an important factor in a human reproductive system particularly during pregnancy and lactation in women. So far, different therapeutic roles for OT have been identified as a spectrum from central and peripheral actions on male and female reproductive systems, circulatory system, musculoskeletal system, etc. Some in vitro and in vivo studies also revealed that OT is responsible for bivariate biological functions involved in cancer as following. By activating OT receptor in tumoral cells, OT enacts as a growth regulator, whether activator or inhibitor. Regarding the increase of OT in some conditions such as breastfeeding, exercise, and multiparity, we can relate the effect of these conditions on cancer with OT effects. Based on this hypothesis, we present a review on the effects of this neuropeptide on various types of cancer and also the influence of these conditions on the same cancer.
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Affiliation(s)
| | - Fereshte Bagheri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammad Alizadeh
- Cancer Research Center, Tehran University of Medical Sciences, PO Box 1419733141, Tehran, Iran.
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Krishnamachari B, Il'yasova D, Scheurer ME, Bondy ML, Wrensch M, Davis FG. A pooled multisite analysis of the effects of female reproductive hormones on glioma risk. Cancer Causes Control 2014; 25:1007-13. [PMID: 24890803 DOI: 10.1007/s10552-014-0400-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The association between female reproductive factors and glioma risk is unclear, but most published studies have been limited by small sample size. We conducted a pooled multisite study of pre- and postmenopausal women, investigating the effect of female reproductive factors, including hormonal medications. METHODS Unconditional logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (95 % CIs) assessing the effects of female reproductive factors and female hormonal medications in glioma cases and unrelated controls. RESULTS Menarche over the age of 15 as compared to under 12 was associated with a statistically significant risk for glioma (OR 2.00, 95 % CI 1.47-2.71). Use of oral contraceptive pills (OCP) was inversely associated with risk of glioma (OR 0.61, 95 % CI 0.50-0.74), and there was an inverse trend with longer duration of OCP use (p for trend <0.0001). Use of hormone replacement therapy (HRT) was also inversely associated with risk of glioma (OR 0.55, 95 % CI 0.44-0.68), and there was an inverse trend with longer duration of use (p for trend <0.0001). Compared to those reporting neither OCP use nor HRT use, those who reported using both were less likely to have a diagnosis of glioma (OR 0.34, 95 % CI 0.24-0.48). CONCLUSIONS Female reproductive hormones may decrease the risk for glioma. The association appears to be strongest with greater length of use and use of both HRT and OCP.
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Affiliation(s)
- Bhuma Krishnamachari
- Department of Medicine, New York Institute of Technology College of Osteopathic Medicine, Northern Boulevard, P.O. Box 8000, Old Westbury, NY, 11568-8000, USA,
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Reproductive factors and risk of primary brain tumors in women. J Neurooncol 2014; 118:297-304. [PMID: 24700240 DOI: 10.1007/s11060-014-1427-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/20/2014] [Indexed: 12/29/2022]
Abstract
Gender-specific incidence patterns and the presence of hormonal receptors on tumor cells suggest that sex hormones may play a role in the onset of primary brain tumors. However, epidemiological studies on the relation of hormonal risk factors to the risk of brain tumors have been inconsistent. We examined the role of reproductive factors in the onset of glioma and meningioma in a case-control study conducted in the Southeastern US that included 507 glioma cases, 247 meningioma cases, and 695 community-based and friend controls. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) adjusting for age, race, US state of residence, and education. An older age at menarche was associated with an increased risk of glioma (≥ 15 vs. ≤ 12 years: OR 1.65; 95% CI 1.11-2.45), with a stronger association observed in pre-menopausal (OR 2.22; 95% CI 1.12-4.39) than post-menopausal (OR 1.55; 95% CI 0.93-2.58) women. When compared to controls, meningioma cases were more likely to have undergone natural menopause (OR 1.52; 95% CI 1.04-2.21) whereas glioma cases were less likely to be long term users of oral contraceptives (OR 0.47; 95% CI 0.33-0.68). Increasing parity was not related to the risk of either tumor. Current findings are consistent with a limited role for hormones in the onset of brain tumors in women. Results contribute to a growing body of evidence that a later age at menarche increases the risk of glioma in women.
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Hernández-Durán S, Sánchez-Jiménez E, Pérez-Berríos J. Hemangiopericytoma of the foramen magnum in a pregnant patient: A case report and literature review. Surg Neurol Int 2014; 5:13. [PMID: 24678429 PMCID: PMC3942593 DOI: 10.4103/2152-7806.125864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/10/2014] [Indexed: 11/04/2022] Open
Abstract
Background: The presentation of intracranial hemangiopericytomas is very rare, and only one case of a hemangiopericytoma during pregnancy has been reported in the literature. The management of these lesions poses a great challenge to the neurosurgeon, since the physiological and hormonal changes of pregnancy can exacerbate the symptoms of this highly vascularized neoplasm and pose different risks to both the mother and the fetus. We report the case of a patient who had sudden onset of intracranial hypertension at the ninth week of gestation due to a hemangiopericytoma of the foramen magnum and review the literature in this regard. Case Description: A 23-year-old female who presented with signs and symptoms of intracranial hypertension at the ninth week of gestation was initially thought to have hyperemesis gravidarum. Because her symptoms persisted, she was found to have intracranial hypertension due to a tumor in the foramen magnum. She was treated by means of derivative surgery to allow for her pregnancy to progress beyond the first trimester, and at the 22nd week of gestation she underwent a sub-occipital craniotomy with partial tumor removal. Pathology was consistent with hemangiopericytoma. Both the mother and the fetus had positive outcomes. Conclusions: To our knowledge, this is the second intracranial hemangiopericytoma presenting during pregnancy to be reported in the literature, and it is the first one of its kind to be located in the foramen magnum and causing severe intracranial hypertension.
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Affiliation(s)
- Silvia Hernández-Durán
- University of Costa Rica School of Medicine, Ciudad Universitaria Rodrigo Facio, San Pedro de Montes de Oca, San José, Costa Rica ; Department of Neurological Surgery, Hospital San Juan de Dios, Paseo Colón, San José, Costa Rica
| | - Esteban Sánchez-Jiménez
- Department of Neurological Surgery, Hospital San Juan de Dios, Paseo Colón, San José, Costa Rica
| | - José Pérez-Berríos
- University of Costa Rica School of Medicine, Ciudad Universitaria Rodrigo Facio, San Pedro de Montes de Oca, San José, Costa Rica ; Department of Neurological Surgery, Hospital San Juan de Dios, Paseo Colón, San José, Costa Rica
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Zeng XT, Lu JT, Tang XJ, Weng H, Luo J. Association of methionine synthase rs1801394 and methionine synthase reductase rs1805087 polymorphisms with meningioma in adults: A meta-analysis. Biomed Rep 2014; 2:432-436. [PMID: 24748989 PMCID: PMC3990204 DOI: 10.3892/br.2014.248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/04/2014] [Indexed: 12/12/2022] Open
Abstract
Several epidemiological studies suggested that methionine synthase (MTRR) rs1801394 and methionine synthase reductase (MTR) rs1805087 polymorphisms may be involved in the risk of meningioma in adults; however, the results from different case-control studies have been inconsistent. Therefore, we performed a meta-analysis to investigate the association of MTRR and MTR polymorphisms with meningioma. PubMed, Web of Knowledge, China National Knowledge Infrastructure and Wanfang databases were searched up to October 30, 2013 and 3 publications, involving 7 case-control studies, were finally included. Following data extraction, a meta-analysis was conducted using Stata 12.0 software. The pooled results based on the fixed effects model demonstrated that the MTRR rs1801394 polymorphism was associated with an increased risk of meningioma [odds ratio (OR)=1.18, 95% confidence interval (CI): 1.05–1.32 for G vs. A; OR=1.41, 95% CI: 1.12–1.77 for GG vs. AA; OR=1.08, 95% CI: 0.94–1.33 for AG vs. AA; OR=1.19, 95% CI: 1.01–1.40 for (AG+GG) vs. AA; and OR=1.32, 95% CI: 1.07–1.63 for GG vs. (AG+AA)]; however, an association between the MTR rs1805087 polymorphism and the risk of meningioma was not identified [OR=0.99, 95% CI: 0.88–1.12 for G vs. A; OR=1.09, 95% CI: 0.80–1.48 for GG vs. AA; OR=0.95, 95% CI: 0.82–1.11 for AG vs. AA; OR=0.97, 95% CI: 0.84–1.13 for (AG+GG) vs. AA; and OR=1.09, 95% CI: 0.80–1.48 for GG vs. (AG+AA)]. Therefore, the currently available evidence suggests that the MTRR rs1801394 polymorphism may increase the risk of meningioma, whereas the MTRR rs1801394 polymorphism is not associated with meningioma.
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Affiliation(s)
- Xian-Tao Zeng
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Jun-Ti Lu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Xiang-Jun Tang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Hong Weng
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Jie Luo
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China ; Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
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Qi ZY, Shao C, Huang YL, Hui GZ, Zhou YX, Wang Z. Reproductive and exogenous hormone factors in relation to risk of meningioma in women: a meta-analysis. PLoS One 2013; 8:e83261. [PMID: 24386167 PMCID: PMC3873952 DOI: 10.1371/journal.pone.0083261] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 11/01/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A number of studies have focused on the association between oral contraceptive (OC), hormonal replacement therapy (HRT) and reproductive factors and meningioma risk, but the results were inconsistent. Thus, a meta-analysis was performed to obtain more precise estimates of risk. METHODS We conducted a literature search using PubMed and EMBASE databases to July 2013, without any limitations. Random effects models were used to summarize results. RESULTS Twelve case-control and six cohort studies were included in this meta-analysis. We found that an increased risk of meningioma was associated with HRT use(RR = 1.19, 95% CI = 1.01-1.40), postmenopausal women(RR = 1.32, 95% CI = 1.07-1.64) and parity(RR = 1.18, 95% CI = 1.00-1.40).No significant associations were observed for OC use (RR = 0.93, 95% CI = 0.83-1.03), age at menarche(RR = 1.06, 95% CI = 0.92-1.21), age at menopause(RR = 1.03, 95% CI = 0.81-1.30), or age at first birth(RR = 0.94, 95% CI = 0.80-1.10). CONCLUSION In conclusion, the results of our study support the hypothesis that longer exposure to effect of female sex hormones may increase the risk of meningioma in women, yet additional studies are warranted to confirm our findings and identify the underlying biological mechanisms.
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Affiliation(s)
- Zhen-Yu Qi
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- * E-mail:
| | - Chuan Shao
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yu-Lun Huang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guo-Zhen Hui
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - You-Xin Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Yen YS, Sun LM, Lin CL, Chang SN, Sung FC, Kao CH. Higher risk for meningioma in women with uterine myoma: a nationwide population-based retrospective cohort study. J Neurosurg 2013; 120:655-61. [PMID: 24313608 DOI: 10.3171/2013.10.jns131357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Evidence suggests that hormones play a role in modifying both uterine myoma (UM) and meningioma. A number of studies have observed the positive association between these diseases. The aim of the current population-based study was to determine if women with UM are at a higher risk for meningioma. METHODS The authors used data from the National Health Insurance system of Taiwan for the study. The UM cohort contained 281,244 women. Each woman was randomly frequency-matched with 4 women without UM, based on age, index year of diagnosis, occupation, urbanization (urbanization level was categorized by the population density of the residential area into 4 levels, with Level 1 as the most urbanized and Level 4 as the least urbanized), and comorbidity, to form the control cohort. Cox's proportional hazard regression analysis was conducted to estimate the influence of UM on the meningioma risk. RESULTS Among women with UM, the risk of developing meningioma was significantly higher (45%) than among women without UM (95% CI 1.23-1.70). The same phenomenon was observed among most age groups, but a significant difference was only seen in the middle-age range. For women with UM, further analysis did not show a significant change after myomectomy. The cumulative incidence of meningioma between groups with and without UM differed over time. CONCLUSIONS The nationwide population-based cohort study found that Taiwanese women with UM are at higher risk for developing meningioma.
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Affiliation(s)
- Yu-Shu Yen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, School of Medicine, National Yang-Ming University, Taipei
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Andersen L, Friis S, Hallas J, Ravn P, Gaist D. Hormone replacement therapy and risk of glioma: a nationwide nested case-control study. Cancer Epidemiol 2013; 37:876-80. [PMID: 24138870 DOI: 10.1016/j.canep.2013.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/18/2013] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
Abstract
AIM Several studies indicate that use of hormone replacement therapy (HRT) is associated with an increased risk of intracranial meningioma, while associations between HRT use and risk of other brain tumors have been less explored. We investigated the influence of HRT use on the risk of glioma in a nationwide setting. METHODS Using population-based registries we conducted a case-control study nested in the Danish female population. We identified all women aged 55-84 years with a first diagnosis of histologically verified brain glioma during 2000-2009. Using risk-set sampling, each case was matched on birth year to eight population controls. Ever use of HRT was defined as ≥2 HRT prescriptions and categorized according to type (oestrogens only, combined oestrogen-progestagen and progestagen only) and duration of use (<1, ≥1 to <5, ≥5 to <10, and ≥10 years). We used conditional logistic regression to compute odds ratios (ORs), with 95% confidence intervals (CIs), for glioma associated with HRT use, adjusting for potential confounders. RESULTS We identified 658 cases and 4350 controls. Ever use of HRT was associated with an OR of 0.9 (95% CI: 0.8-1.1) for glioma. For long-term use (≥10 years) we found ORs of 1.1 (95% CI: 0.7-1.7) for HRT overall, 1.6 (95% CI: 0.9-2.6) for oestrogen only, 0.8 (0.4-1.6) for combined oestrogen-progestagen, and 2.2 (0.9-5.5) for progestagen. Tests for trends were statistically non-significant in all strata. CONCLUSION Use of HRT overall was not associated with an increased risk of glioma. However, our findings indicate that prolonged use of oestrogen only or progestagen may be associated with an increased risk of glioma.
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Affiliation(s)
- Lene Andersen
- Department of Neurology, Odense University Hospital, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Emerging association between androgen deprivation therapy and male meningioma: significant expression of luteinizing hormone-releasing hormone receptor in male meningioma. Prostate Cancer Prostatic Dis 2013; 16:387-90. [PMID: 24100643 DOI: 10.1038/pcan.2013.45] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/01/2013] [Accepted: 08/29/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is emerging data suggesting a potential risk for meningioma growth stimulation in patients on luteinizing hormone-releasing hormone (LHRH) analogs for prostate cancer. We examined the expression of LHRH receptor (LHRH-R), progesterone receptor (PR) and Ki67 labeling index (LI) in specimens from male meningioma (MM) and female meningioma (FM) patients. METHODS A total of 24 MM and 24 FM paraffin blocks were retrieved from our institution between 1991 and 2008. Sections from the paraffin blocks were stained with mouse monoclonal antibodies against LHRH-R, PR and Ki67. All male patients had no previous history of prostate cancer (PCa) or previous history of hormone therapy. RESULTS LHRH-R positivity was extensive in 92% of MM and 88% of FM samples, with both showing strong intensity (67% and 79%, respectively). PR was positive in 20 of 24 (83%) MM and 23 of 24 (96%) FM samples. MM is less likely to exhibit Ki67 LI >4% compared with FM. CONCLUSIONS The majority of MM and FM samples were strongly positive for LHRH-R expression and PR expression. The emerging association of androgen deprivation therapy and meningioma growth should be recognized in urological practice. Caution should be taken when considering LHRH agonist administration for patients with PCa and concurrent meningioma or previous history of meningioma.
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Exogenous and endogenous hormones in relation to glioma in women: a meta-analysis of 11 case-control studies. PLoS One 2013; 8:e68695. [PMID: 23874728 PMCID: PMC3712935 DOI: 10.1371/journal.pone.0068695] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 05/31/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Previous investigations of glioma risk in women have focused on oral contraceptive (OC), hormone replacement therapy (HRT), and reproductive factors. However, the results of published studies were inconclusive and inconsistent. Thus, a meta-analysis based on published case-control studies was performed to assess the role of exogenous and endogenous hormones factors in glioma risk. METHODS The PubMed and EMBASE databases were searched without any restrictions on language or publication year. Reference lists from retrieved articles were also reviewed. We included case-control studies reporting relative risks (RRs) with corresponding 95% confidence intervals (CIs) (or data to calculate them) between oral contraceptive (OC) and hormone replacement therapy (HRT) use, reproductive factors and glioma. Random-effects models were used to calculate the summary risk estimates. RESULTS Finally, 11 eligible studies with 4860 cases and 14,740 controls were identified. A lower risk of glioma was observed among women who were ever users of exogenous hormones (OC RR = 0.707, 95% CI = 0.604-0.828; HRT: RR = 0.683, 95% CI = 0.577-0.808) compared with never users. An increased glioma risk was associated with older age at menarche (RR = 1.401, 95% CI = 1.052-1.865). No association was observed for menopause status, parous status, age at menopause, or age at first birth and glioma risk. CONCLUSION The results of our study support the hypothesis female sex hormones play a role in the development of glioma in women. Additional studies are warranted to validate the conclusion from this meta-analysis and clarity the underlying mechanisms.
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Fan ZX, Shen J, Wu YY, Yu H, Zhu Y, Zhan RY. Hormone replacement therapy and risk of meningioma in women: a meta-analysis. Cancer Causes Control 2013; 24:1517-25. [PMID: 23702884 DOI: 10.1007/s10552-013-0228-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/07/2013] [Indexed: 01/30/2023]
Abstract
PURPOSE The relationship between hormone replacement therapy (HRT) and the incidence of meningioma in women has been investigated in several epidemiologic studies, but their results were not entirely consistent. Here, we performed a meta-analysis of case-control and cohort studies to analyze this association. METHODS The PubMed database was searched from inception to 30 September 2012 to identify relevant studies that met pre-stated inclusion criteria. We also reviewed reference lists from the retrieved articles. Two researchers evaluated study eligibility and extracted the data independently. Odds ratios (ORs) or relative risks and 95 % confidence intervals (CIs) were extracted and pooled using the fixed-effect or random-effects models. RESULTS A total of 11 studies (six case-control and five cohort studies) were included in this meta-analysis, involving 1,820,954 participants, of whom 3,249 had meningioma. When compared to never users of HRT, the pooled OR with ever users for meningioma was 1.29 (95 % CI 1.03-1.60). Sensitivity analyses restricted to postmenopausal women yielded similar results (OR: 1.22; 95 % CI 1.02-1.46). Subgroup analyses showed that the pooled ORs were 1.27 (95 % CI 1.08-1.49, p < 0.05) and 1.12 (95 % CI 0.95-1.32) for current and past users of HRT, respectively. CONCLUSION Hormone replacement therapy use is associated with an increased risk of meningioma in women, as well as in postmenopausal women. Besides, the significant risk elevation is present in current users but not in past users. Future research should attempt to establish whether this association is causal and to clarify its mechanisms.
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Affiliation(s)
- Zuo-Xu Fan
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, NO.79, Qingchun Road, Hangzhou, 310000, People's Republic of China.
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Symptomatic meningioma induced by cross-sex hormone treatment in a male-to-female transsexual. ACTA ACUST UNITED AC 2013; 60:264-7. [DOI: 10.1016/j.endonu.2012.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/02/2012] [Accepted: 07/06/2012] [Indexed: 11/23/2022]
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Claus EB, Calvocoressi L, Bondy ML, Wrensch M, Wiemels JL, Schildkraut JM. Exogenous hormone use, reproductive factors, and risk of intracranial meningioma in females. J Neurosurg 2013; 118:649-56. [PMID: 23101448 PMCID: PMC3756881 DOI: 10.3171/2012.9.jns12811] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The 2-fold higher incidence of meningioma in women compared with men has long suggested a role for hormonally mediated risk factors, but specific mechanisms remain elusive. METHODS The study included data obtained in 1127 women 29-79 years of age with intracranial meningioma diagnosed among residents of Connecticut, Massachusetts, North Carolina, the San Francisco Bay Area, and 8 Texas counties between May 1, 2006, and October 6, 2011, and data obtained in 1092 control individuals who were frequency matched for age group and geography with meningioma patients. RESULTS No association was observed for age at menarche, age at menopause, or parity and meningioma risk. Women who reported breastfeeding for at least 6 months were at reduced risk of meningioma (OR 0.78, 95% CI 0.63-0.96). A significant positive association existed between meningioma risk and increased body mass index (p < 0.01) while a significant negative association existed between meningioma risk and current smoking (p < 0.01). Among premenopausal women, current use of oral contraceptives was associated with an increased risk of meningiomas (OR 1.8, 95% CI 1.1-2.9), while current use of hormone replacement therapy among postmenopausal women was not associated with a significant elevation in risk (OR 1.1, 95% CI 0.74-1.67). There was no association between use of fertility medications and meningioma risk. CONCLUSIONS The authors' study confirms associations for body mass index, breastfeeding, and cigarette smoking but provides little evidence for associations of reproductive and menstrual factors with meningioma risk. The relationship between current use of exogenous hormones and meningioma remains unclear, limited by the small numbers of patients currently on oral hormone medications and a lack of hormone receptor data for meningioma tumors.
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Affiliation(s)
- Elizabeth B Claus
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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