Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
J Cancer Res Clin Oncol. 2018 May;144(5):969-978. doi: 10.1007/s00432-018-2618-4. Epub 2018 Mar 2.
The initial management of atypical meningiomas poses a distinct clinical challenge in that treatment protocols have not been fully established, and outcomes, especially differences by patient age, have not been broadly measured. The National Cancer Database (NCDB) allows for analysis of a large, diverse patient population to determine clinical parameters and survival outcomes based on the initial treatment of patients with atypical meningiomas.
Analysis of the NCDB yielded 3611 atypical meningioma patients treated between 2008 and 2012. Principal treatment paradigms included surgery with or without radiation. Survival estimates were calculated using Kaplan-Meier curves stratified by age at diagnosis for each treatment paradigm. Subset analysis was performed for socio-economic factors.
Overall 5-year survival rate was 77.6% and declined with increasing patient age (p < 0.0001). Five-year survival for patients ≤ 45 years undergoing surgery alone was 89.3 vs. 44.4% for those > 75 years (p < 0.0001). For patients undergoing surgery with adjuvant radiation, 5-year survival was 93.7% in those ≤ 45 years and 54.1% in those > 75 years (p < 0.0001). Use of adjuvant radiation was stable over time. Private-insured patients were more likely to receive adjuvant radiation (p = 0.0001).
Patients treated for atypical meningioma have high rates of 5-year survival. A marginal survival benefit of adjuvant radiation was observed for patients < 55 and > 75 years, while patients between 55 and 75 years tended to have slightly improved survival with surgery alone. Though surgery remains the standard of care in the primary treatment of atypical meningioma, the decision to administer radiation post-operatively has remained controversial.
非典型脑膜瘤的初始治疗存在明显的临床挑战，因为尚未完全建立治疗方案，而且尚未广泛测量结果，尤其是按患者年龄的差异。国家癌症数据库（NCDB）允许对大量不同的患者人群进行分析，以根据非典型脑膜瘤患者的初始治疗确定临床参数和生存结果。
对 NCDB 进行分析，得出 3611 例在 2008 年至 2012 年间接受治疗的非典型脑膜瘤患者。主要治疗方案包括手术加或不加放疗。使用 Kaplan-Meier 曲线按每种治疗方案的诊断时年龄进行分层来计算生存估计值。对社会经济因素进行了亚组分析。
总体 5 年生存率为 77.6%，并随患者年龄的增加而下降（p<0.0001）。仅接受手术的≤45 岁患者 5 年生存率为 89.3%，而>75 岁患者为 44.4%（p<0.0001）。对于接受手术加辅助放疗的患者，≤45 岁的 5 年生存率为 93.7%，而>75 岁的为 54.1%（p<0.0001）。辅助放疗的使用随时间保持稳定。私人保险患者更有可能接受辅助放疗（p=0.0001）。
接受非典型脑膜瘤治疗的患者 5 年生存率较高。对于<55 岁和>75 岁的患者，辅助放疗有轻微的生存获益，而 55-75 岁的患者单独手术治疗的生存略有改善。尽管手术仍然是非典型脑膜瘤的标准治疗方法，但术后是否进行放疗的决定仍存在争议。
