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01-12-2023 | Meningioma | Research

Decision-making tree for surgical treatment in meningioma: a geriatric cohort study

Authors: Haoyi Li, Dao Zheng, Yonggang Wang, Yuzhe Ying, Dali Sui, Song Lin, Zhongli Jiang, Huawei Huang, Guobin Zhang

Published in: Neurosurgical Review | Issue 1/2023

Abstract

Controversies persist regarding the benefits of surgery in elderly patients with meningiomas. The objective of this study was to develop decision-making scale to clarify the necessity for surgical intervention and provide clinical consultation for this special population. This retrospective cohort study was conducted at a single center and included 478 elderly patients (≥ 65 years) who underwent meningioma resection. Follow-up was recorded to determine recurrence and mortality rates. Univariate and multivariate analyses were performed to identify significantly preoperative factors, and prognostic prediction models were developed with determined cutoff values for the prognostic index (PI). Model discrimination was evaluated using Kaplan-Meier curves based on the PI stratification, which categorized patients into low- and high-risk groups. A decision-making tree was then established based on the risk stratification from both models. Among all patients analyzed (n = 478), 62 (13.0%) experience recurrence and 47 (10.0%) died during the follow-up period. Significantly preoperative parameters from both models included advanced age, aCCI, recurrent tumor, motor cortex involvement, male sex, peritumoral edema, and tumor located in skull base (all P < 0.05). According to the classification of PI from the two models, the decision-making tree provided four recommendations that can be used for clinical consultation. Surgery is not recommended for patients assigned to the high-risk group in both models. Patients who meet the low-risk criteria in any model may undergo surgical intervention, but the final decision should depend on the surgeon’s expertise.

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Baldi I, Engelhardt J, Bonnet C, Bauchet L, Berteaud E, Grüber A, Loiseau H (2018) Epidemiology of meningiomas. Neuro-Chirurgie 64:5–14. https://doi.org/10.1016/j.neuchi.2014.05.006CrossRefPubMed

Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, Stroup NE, Kruchko C, Barnholtz-Sloan JS (2013) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2006-2010. Neuro Oncol 15(Suppl 2):ii1–ii56. https://doi.org/10.1093/neuonc/not151CrossRefPubMedPubMedCentral

Davis FG, Kupelian V, Freels S, McCarthy B, Surawicz T (2001) Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro Oncol 3:152–158. https://doi.org/10.1093/neuonc/3.3.152CrossRefPubMedPubMedCentral

McCarthy BJ, Davis FG, Freels S, Surawicz TS, Damek DM, Grutsch J, Menck HR, Laws ER Jr (1998) Factors associated with survival in patients with meningioma. J Neurosurg 88:831–839. https://doi.org/10.3171/jns.1998.88.5.0831CrossRefPubMed

Porter KR, McCarthy BJ, Freels S, Kim Y, Davis FG (2010) Prevalence estimates for primary brain tumors in the United States by age, gender, behavior, and histology. Neuro Oncol 12:520–527. https://doi.org/10.1093/neuonc/nop066CrossRefPubMedPubMedCentral

Radhakrishnan K, Mokri B, Parisi JE, O'Fallon WM, Sunku J, Kurland LT (1995) The trends in incidence of primary brain tumors in the population of Rochester, Minnesota. Ann Neurol 37:67–73. https://doi.org/10.1002/ana.410370113CrossRefPubMed

Bailo M, Gagliardi F, Boari N, Castellano A, Spina A, Mortini P (2019) The role of surgery in meningiomas. Curr Treat Options Neurol 21:51. https://doi.org/10.1007/s11940-019-0587-9CrossRefPubMed

Cea-Soriano L, Wallander MA, García Rodríguez LA (2012) Epidemiology of meningioma in the United Kingdom. Neuroepidemiology 39:27–34. https://doi.org/10.1159/000338081CrossRefPubMed

Christensen HC, Kosteljanetz M, Johansen C (2003) Incidences of gliomas and meningiomas in Denmark, 1943 to 1997. Neurosurgery 52:1327–1333. https://doi.org/10.1227/01.neu.0000064802.46759.53CrossRefPubMed

10.

Jukich PJ, McCarthy BJ, Surawicz TS, Freels S, Davis FG (2001) Trends in incidence of primary brain tumors in the United States, 1985-1994. Neuro Oncol 3:141–151. https://doi.org/10.1093/neuonc/3.3.141CrossRefPubMedPubMedCentral

11.

Kim KH, Kang SJ, Choi JW, Kong DS, Seol HJ, Nam DH, Lee JI (2018) Clinical and radiological outcomes of proactive Gamma Knife surgery for asymptomatic meningiomas compared with the natural course without intervention. J Neurosurg:1–10. https://doi.org/10.3171/2017.12.Jns171943

12.

Nakamura H, Makino K, Yano S, Kuratsu J (2011) Epidemiological study of primary intracranial tumors: a regional survey in Kumamoto prefecture in southern Japan--20-year study. Int J Clin Oncol 16:314–321. https://doi.org/10.1007/s10147-010-0178-yCrossRefPubMed

13.

Hoffman S, Propp JM, McCarthy BJ (2006) Temporal trends in incidence of primary brain tumors in the United States, 1985-1999. Neuro-oncology 8:27–37. https://doi.org/10.1215/s1522851705000323CrossRefPubMedPubMedCentral

14.

Nabors LB, Portnow J, Ahluwalia M, Baehring J, Brem H, Brem S, Butowski N, Campian JL, Clark SW, Fabiano AJ, Forsyth P, Hattangadi-Gluth J, Holdhoff M, Horbinski C, Junck L, Kaley T, Kumthekar P, Loeffler JS, Mrugala MM et al (2020) Central nervous system cancers, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 18:1537–1570. https://doi.org/10.6004/jnccn.2020.0052CrossRefPubMed

15.

de Boer AW, Drewes YM, de Mutsert R, Numans ME, den Heijer M, Dekkers OM, de Roos A, Lamb HJ, Blom JW, Reis R (2018) Incidental findings in research: a focus group study about the perspective of the research participant. J Magn Reson Imaging 47:230–237. https://doi.org/10.1002/jmri.25739CrossRefPubMed

16.

Patil CG, Veeravagu A, Lad SP, Boakye M (2010) Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the National Surgical Quality Improvement Program. J Neurol Neurosurg Psychiatry 81:502–505. https://doi.org/10.1136/jnnp.2009.185074CrossRefPubMed

17.

Sacko O, Sesay M, Roux FE, Riem T, Grenier B, Liguoro D, Loiseau H (2007) Intracranial meningioma surgery in the ninth decade of life. Neurosurgery 61:950–954. https://doi.org/10.1227/01.neu.0000303190.80049.7dCrossRefPubMed

18.

Yamamoto J, Takahashi M, Idei M, Nakano Y, Soejima Y, Akiba D, Kitagawa T, Ueta K, Miyaoka R, Nishizawa S (2017) Clinical features and surgical management of intracranial meningiomas in the elderly. Oncol Lett 14:909–917. https://doi.org/10.3892/ol.2017.6174CrossRefPubMedPubMedCentral

19.

Koppie TM, Serio AM, Vickers AJ, Vora K, Dalbagni G, Donat SM, Herr HW, Bochner BH (2008) Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer 112:2384–2392. https://doi.org/10.1002/cncr.23462CrossRefPubMed

20.

Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, Hawkins C, Ng HK, Pfister SM, Reifenberger G, Soffietti R, von Deimling A, Ellison DW (2021) The 2021 WHO Classification of tumors of the central nervous system: a summary. Neuro Oncol 23:1231–1251. https://doi.org/10.1093/neuonc/noab106CrossRefPubMedPubMedCentral

21.

Terrapon APR, Zattra CM, Voglis S, Velz J, Vasella F, Akeret K, Held U, Schiavolin S, Bozinov O, Ferroli P, Broggi M, Sarnthein J, Regli L, Neidert MC (2021) Adverse events in neurosurgery: the novel therapy-disability-neurology grade. Neurosurgery 89:236–245. https://doi.org/10.1093/neuros/nyab121CrossRefPubMed

22.

Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, von Deimling A, Stavrinou P, Lefranc F, Lund-Johansen M, Moyal EC, Brandsma D, Henriksson R, Soffietti R, Weller M (2016) EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 17:e383–e391. https://doi.org/10.1016/S1470-2045(16)30321-7CrossRefPubMed

23.

Spille DC, Adeli A, Sporns PB, Heß K, Streckert EMS, Brokinkel C, Mawrin C, Paulus W, Stummer W, Brokinkel B (2021) Predicting the risk of postoperative recurrence and high-grade histology in patients with intracranial meningiomas using routine preoperative MRI. Neurosurg Rev 44:1109–1117. https://doi.org/10.1007/s10143-020-01301-7CrossRefPubMed

24.

Czernicki T (2020) Surgical management of intracranial meningiomas in the elderly: early and long-term outcomes. Clin Interv Aging 15:2439–2451. https://doi.org/10.2147/CIA.S283678CrossRefPubMedPubMedCentral

25.

Monden D, Raimann FJ, Neef V, Dubinski D, Gessler F, Keil F, Forster MT, Ronellenfitsch MW, Harter PN, Freiman TM, Hattingen E, Seifert V, Senft C, Baumgarten P (2021) Meningioma surgery in patients >/=70 years of age: clinical outcome and validation of the SKALE score. J Clin Med 10. https://doi.org/10.3390/jcm10091820

26.

Hajian-Tilaki K (2013) Receiver Operating Characteristic (ROC) Curve analysis for medical diagnostic test evaluation. Caspian J Intern Med 4:627–635PubMedPubMedCentral

27.

Achey RL, Gittleman H, Schroer J, Khanna V, Kruchko C, Barnholtz-Sloan JS (2019) Nonmalignant and malignant meningioma incidence and survival in the elderly, 2005-2015, using the Central Brain Tumor Registry of the United States. Neuro-oncology 21:380–391. https://doi.org/10.1093/neuonc/noy162CrossRefPubMed

28.

Bateman BT, Pile-Spellman J, Gutin PH, Berman MF (2005) Meningioma resection in the elderly: nationwide inpatient sample, 1998-2002. Neurosurgery 57:866–872. https://doi.org/10.1227/01.neu.0000179923.66729.87CrossRefPubMed

29.

Brokinkel B, Holling M, Spille DC, Heß K, Sauerland C, Bleimüller C, Paulus W, Wölfer J, Stummer W (2017) Surgery for meningioma in the elderly and long-term survival: comparison with an age- and sex-matched general population and with younger patients. J Neurosurg 126:1201–1211. https://doi.org/10.3171/2016.2.Jns152611CrossRefPubMed

30.

Cohen-Inbar O, Soustiel JF, Zaaroor M (2010) Meningiomas in the elderly, the surgical benefit and a new scoring system. Acta Neurochir 152:87–97. https://doi.org/10.1007/s00701-009-0552-6CrossRefPubMed

31.

van Alkemade H, de Leau M, Dieleman EM, Kardaun JW, van Os R, Vandertop WP, van Furth WR, Stalpers LJ (2012) Impaired survival and long-term neurological problems in benign meningioma. Neuro-oncology 14:658–666. https://doi.org/10.1093/neuonc/nos013CrossRefPubMedPubMedCentral

32.

Caroli M, Locatelli M, Prada F, Beretta F, Martinelli-Boneschi F, Campanella R, Arienta C (2005) Surgery for intracranial meningiomas in the elderly: a clinical-radiological grading system as a predictor of outcome. J Neurosurg 102:290–294. https://doi.org/10.3171/jns.2005.102.2.0290CrossRefPubMed

33.

Chen ZY, Zheng CH, Tang L, Su XY, Lu GH, Zhang CY, Xiao SW, Tan YF (2015) Intracranial meningioma surgery in the elderly (over 65 years): prognostic factors and outcome. Acta Neurochir 157:1549–1557. https://doi.org/10.1007/s00701-015-2502-9CrossRefPubMed

34.

Lieu AS, Howng SL (1998) Surgical treatment of intracranial meningiomas in geriatric patients. Kaohsiung J Med Sci 14:498–503PubMed

35.

Poon MT, Fung LH, Pu JK, Leung GK (2013) Outcome comparison between younger and older patients undergoing intracranial meningioma resections. J Neurooncol 114:219–227. https://doi.org/10.1007/s11060-013-1173-8CrossRefPubMed

36.

Poon MT, Fung LH, Pu JK, Leung GK (2014) Outcome of elderly patients undergoing intracranial meningioma resection--a systematic review and meta-analysis. Br J Neurosurg 28:303–309. https://doi.org/10.3109/02688697.2013.841857CrossRefPubMed

37.

Cahill DW, Bashirelahi N, Solomon LW, Dalton T, Salcman M, Ducker TB (1984) Estrogen and progesterone receptors in meningiomas. J Neurosurg 60:985–993. https://doi.org/10.3171/jns.1984.60.5.0985CrossRefPubMed

38.

Tilzer LL, Plapp FV, Evans JP, Stone D, Alward K (1982) Steroid receptor proteins in human meningiomas. Cancer 49:633–636. https://doi.org/10.1002/1097-0142(19820215)49:4<633::aid-cncr2820490404>3.0.co;2-4CrossRefPubMed

39.

Ehresman JS, Garzon-Muvdi T, Rogers D, Lim M, Gallia GL, Weingart J, Brem H, Bettegowda C, Chaichana KL (2019) Risk of developing postoperative deficits based on tumor location after surgical resection of an intracranial meningioma. J Neurol Surg B Skull Base 80:59–66. https://doi.org/10.1055/s-0038-1667066CrossRefPubMed

Title: Decision-making tree for surgical treatment in meningioma: a geriatric cohort study
Authors: Haoyi Li
Dao Zheng
Yonggang Wang
Yuzhe Ying
Dali Sui
Song Lin
Zhongli Jiang
Huawei Huang
Guobin Zhang
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Meningioma
Meningioma
Edema
Published in: Neurosurgical Review / Issue 1/2023
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-023-02103-3

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Decision-making tree for surgical treatment in meningioma: a geriatric cohort study

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