Markey Cancer Center, University of Kentucky, Lexington, KY, United States.
Department of Neurology, University of Kentucky, Lexington, KY, United States.
Cancer Epidemiol. 2019 Jun;60:16-22. doi: 10.1016/j.canep.2019.02.018. Epub 2019 Mar 14.
Meningiomas are the most common central nervous system tumor. We describe current trends in treatment and survival using the largest cancer dataset in the United States.
We analyzed the National Cancer Database from 2004 to 2014, for all patients with diagnosis of meningioma.
201,765 cases were analyzed. Patients were most commonly White (81.9%) females (73.2%) with a median age of 64 years. Fifty percent of patients were diagnosed by imaging. Patients were reported as grade I (24.9%), grade II (5.0%), grade III (0.7%), or unknown WHO grade (69.4%). Patients diagnosed by imaging were older, received treatment in community facilities, had higher Charlson-Deyo score, and a lower rate of private insurance. Watchful waiting was the most common treatment modality (46.7%), followed by surgery only (40%). Grade II and III patients were more likely to receive therapy. Watchful waiting increased from 35.2% in 2004 to 51.4% in 2014. Younger age, male gender, private insurance, and treatment in academic facilities were determinants for receipt of surgery and/or radiation. Median survival was 12.6 years, higher in histologically confirmed cases (13.1 years). Older patients, Blacks, males, those that received radiation plus surgery, and were treated in community facilities had an increased risk of mortality.
Over half of patients were diagnosed by imaging, suggesting a higher role of clinical determinants over histological confirmation in treatment decisions. Watchful waiting as initial management is increasing. Our survival analysis favored histological confirmation. Patients receiving radiation and surgery had an increased risk of mortality.
脑膜瘤是最常见的中枢神经系统肿瘤。我们使用美国最大的癌症数据库描述当前的治疗趋势和生存情况。
我们分析了 2004 年至 2014 年国家癌症数据库中所有脑膜瘤患者的资料。
共分析了 201765 例患者。患者最常见的是白人（81.9%）和女性（73.2%），中位年龄为 64 岁。50%的患者通过影像学诊断。患者报告为 I 级（24.9%）、II 级（5.0%）、III 级（0.7%）或未知的世界卫生组织分级（69.4%）。通过影像学诊断的患者年龄较大，在社区医疗机构接受治疗，Charlson-Deyo 评分较高，私人保险率较低。观察等待是最常见的治疗方式（46.7%），其次是单纯手术（40%）。II 级和 III 级患者更可能接受治疗。观察等待从 2004 年的 35.2%增加到 2014 年的 51.4%。年轻、男性、私人保险以及在学术机构接受治疗是接受手术和/或放疗的决定因素。中位生存时间为 12.6 年，组织学证实病例的生存时间更高（13.1 年）。年龄较大、黑人、男性、接受放疗加手术治疗以及在社区医疗机构接受治疗的患者死亡风险增加。
超过一半的患者通过影像学诊断，这表明在治疗决策中，临床因素比组织学证实更为重要。作为初始治疗的观察等待正在增加。我们的生存分析有利于组织学证实。接受放疗和手术的患者死亡风险增加。
