Dutta Sunil W, Peterson Jennifer L, Vallow Laura A, Mahajan Anita, Rosenfeld Steven S, Quiñones-Hinojosa Alfredo, Trifiletti Daniel M
Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.
Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
J Clin Neurosci. 2018 Sep;55:17-24. doi: 10.1016/j.jocn.2018.06.026. Epub 2018 Jun 15.
To analyze the national treatment trends of patients diagnosed with benign intracranial meningioma.
Data was obtained from the National Cancer Database (NCDB) for patients with WHO grade I meningioma tumors between 2004 and 2014 (190,527 patients), diagnosed by either surgical specimen or diagnostic imaging. Univariable and multivariable analyses (binary logistic models) were performed to generate odds ratios (OR) and investigate factors associated with definitive initial treatment compared to initial observation. Initial treatments considered included surgical resection and/or radiation, including either fractionated external beam radiotherapy (EBRT) or stereotactic radiosurgery (SRS).
The rate of observation increased over time, from 37% in 2004 to 55% in 2014 (p < 0.001). Conjointly, the rate of resection decreased from 50% to 37% from 2004 to 2014 (p < 0.001). The utilization of radiotherapy, including SRS, remained generally stable over time at 6% or less. SRS was more frequently utilized, compared to EBRT, as definitive treatment (4.6% versus 1.7%, respectively, p < 0.001). Compared to Community Cancer programs, patients at Academic/Research programs were more likely to receive definitive initial treatment over observation (OR = 2.909, each p < 0.001).
There is a national trend favoring initial observation for radiographically diagnosed WHO grade I meningioma. However, patients presenting to academic facilities are more likely to receive definitive initial treatment. Further research into differing approaches among treatment facilities for this common tumor may help clarify this trend.
分析被诊断为良性颅内脑膜瘤患者的全国治疗趋势。
数据取自国家癌症数据库（NCDB），涉及2004年至2014年间被诊断为世界卫生组织（WHO）I级脑膜瘤肿瘤的患者（190,527例），这些患者通过手术标本或诊断成像确诊。进行单变量和多变量分析（二元逻辑模型）以生成优势比（OR），并调查与初始观察相比确定性初始治疗相关的因素。考虑的初始治疗包括手术切除和/或放疗，包括分次外照射放疗（EBRT）或立体定向放射外科治疗（SRS）。
观察率随时间增加，从2004年的37%增至2014年的55%（p<0.001）。同时，切除率从2004年的50%降至2014年的37%（p<0.001）。包括SRS在内的放疗利用率随时间总体保持稳定，在6%或更低水平。与EBRT相比，SRS作为确定性治疗更常被使用（分别为4.6%和1.7%，p<0.001）。与社区癌症项目相比，学术/研究项目的患者比观察更有可能接受确定性初始治疗（OR = 2.909，各p<0.001）。
对于影像学诊断的WHO I级脑膜瘤，全国存在倾向于初始观察的趋势。然而，前往学术机构就诊 的患者更有可能接受确定性初始治疗。对这种常见肿瘤在不同治疗机构中的不同治疗方法进行进一步研究可能有助于阐明这一趋势。
