Garzon-Muvdi T, Yang W, Lim M, Brem H, Huang J
Department of Neurosurgery, Johns Hopkins Hospital, 1800 Orleans Street, Zayed 6115F, Baltimore, MD, 21287, USA.
J Neurooncol. 2017 Jun;133(2):321-330. doi: 10.1007/s11060-017-2436-6. Epub 2017 Apr 20.
Atypical and anaplastic meningiomas (AAM) are aggressive tumors. This study is aimed at examining associations between patient and tumor-related factors and tumor-related death in patients with AAM. We conducted a population-based cohort study utilizing prospectively collected data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with diagnosis of AAM from 1973 to 2012 in the SEER database were included. Patients lacking clinical information were excluded. Multivariate analysis between patient and lesion characteristics, and AAM-related death was performed to adjust for confounding factors. We identified and included 522 patients in our study. Mean age at diagnosis was 60.8 ± 15.7 years. The majority of patients were White(73%), 15.5% Black, and 9.8% Asian. Average tumor size was 48.2 ± 20.3 mm. The tumor was locally confined in 57.1%, whereas it had intracranial extension in 29.3%, and extracranial extension in 8.8% of patients. The vast majority (94.8%) of tumors were supratentorial. Gross total resection (GTR) was documented in 65.5% of patients. Age at diagnosis (p = 0.001), tumor size (p = 0.003), surgery result (GTR vs. subtotal resection, p = 0.027), and radiation therapy (p = 0.2) were found to be significantly different between the comparison groups. In a multivariate proportional competing risk regression analysis age (HR 1.03, CI [1.01,1.04], p < 0.001), infratentorial location (HR 2.81, CI [1.20, 6.56], p = 0.017), tumor size (HR 1.01, CI [1.00,1.02], p = 0.032),and radiation treatment (HR 1.52, CI [1.11, 2.09], p = 0.01) were significantly associated with tumor-related death. The association of age at diagnosis, tumor size, location, and radiotherapy with overall survival in patients with AAM is demonstrated. The results provide a context for individualized treatment plans in patients with AAM. Additional studies focusing on issues such as the use of radiation and chemotherapy will clarify the best modality to achieve disease control.
非典型和间变性脑膜瘤（AAM）是侵袭性肿瘤。本研究旨在探讨AAM患者的患者及肿瘤相关因素与肿瘤相关死亡之间的关联。我们利用监测、流行病学和最终结果（SEER）数据库中前瞻性收集的数据进行了一项基于人群的队列研究。纳入了1973年至2012年在SEER数据库中诊断为AAM的患者。排除缺乏临床信息的患者。对患者和病变特征与AAM相关死亡进行多变量分析以调整混杂因素。我们在研究中识别并纳入了522例患者。诊断时的平均年龄为60.8±15.7岁。大多数患者为白人（73%），15.5%为黑人，9.8%为亚洲人。平均肿瘤大小为48.2±20.3mm。57.1%的肿瘤局限于局部，而29.3%的肿瘤有颅内扩展，8.8%的患者有颅外扩展。绝大多数（94.8%）肿瘤位于幕上。65.5%的患者记录有全切除（GTR）。发现诊断时年龄（p = 0.001）、肿瘤大小（p = 0.003）、手术结果（GTR与次全切除，p = 0.027）和放疗（p = 0.2）在比较组之间有显著差异。在多变量比例竞争风险回归分析中，年龄（HR 1.03，CI [1.01,1.04]，p < 0.001）、幕下位置（HR 2.81，CI [1.20, 6.56]，p = 0.017）、肿瘤大小（HR 1.01，CI [1.00,1.02]，p = 0.032）和放疗（HR 1.52，CI [1.11, 2.09]，p = 0.01）与肿瘤相关死亡显著相关。证实了诊断时年龄、肿瘤大小、位置和放疗与AAM患者总生存的关联。研究结果为AAM患者的个体化治疗方案提供了依据。聚焦于放疗和化疗使用等问题的更多研究将阐明实现疾病控制的最佳方式。
