Champeaux Charles, Houston Deborah, Dunn Laurence, Resche-Rigon Matthieu
Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
INSERM U1153, Statistic and Epidemiologic Research Centre Sorbonne Paris Cite (CRESS), ECSTRA team, Universite Diderot - Paris 7, USPC, Paris, France.
Acta Neurochir (Wien). 2019 Nov 9. doi: 10.1007/s00701-019-04096-9.
Studies on meningioma are reported with inadequate allowance for competing causes of progression or death. The aim of this study was to describe the outcome of patients with intracranial WHO grade I meningioma and identify factors that may influence disease progression and cause-specific survival.
Pathology reports and clinical data of 505 WHO grade I meningiomas treated between January 2003 and December 2017 were retrospectively reviewed at a single institution. We estimated a cumulative incidence function for progression and cause-specific mortality. A competing risk analysis was conducted on clinical and histological criteria. Median follow-up was 6.2 years.
A total of 530 surgical resections were performed on 505 cases. Forty-one patients received radiotherapy (RT). At data collection, 84 patients had died of their meningioma disease or demonstrated a recurrence eventually treated by redo surgery or RT. The risks of recurrence or meningioma-related death at 5 years were 16.2%, CI[12.5, 20], whereas 5-year overall survival was 86.1%, CI[82.8, 89.6]. In the multivariable Fine-Gray regression for a competing risk model, venous sinus invasion (SHR = 1.8, CI[1.1, 2.9], p0.028), extent of resection (SHR = 0.2, CI[0.1, 0.3], p < 0.001), and progressing meningioma (SHR = 7, CI[3.3, 14.8], p < 0.001) were established as independent prognostic factors of cause-specific death or meningioma progression. In contrast, age at diagnosis < 65 years (HR = 1.1, CI[1, 1.1], p < 0.001) and redo surgery for meningioma recurrence (HR = 2.6, CI[1.4, 5], p = 0.00252) were predictors of the overall survival.
In this large series, WHO grade I meningioma treatment failure correlated with venous sinus invasion, incomplete resection, and progressing tumour; shorter survival correlated with increased age and redo surgery for recurrence. We recommend the cumulative incidence competing risk approach in WHO grade I meningioma studies where unrelated mortality may be substantial, as this approach results in more accurate estimates of disease risk and associated predictors.
关于脑膜瘤的研究报告中，对进展或死亡的竞争原因考虑不足。本研究的目的是描述颅内世界卫生组织（WHO）I级脑膜瘤患者的预后，并确定可能影响疾病进展和特定病因生存率的因素。
回顾性分析了2003年1月至2017年12月期间在单一机构接受治疗的505例WHO I级脑膜瘤的病理报告和临床数据。我们估计了进展和特定病因死亡率的累积发病率函数。对临床和组织学标准进行了竞争风险分析。中位随访时间为6.2年。
505例患者共进行了530次手术切除。41例患者接受了放疗（RT）。在数据收集时，84例患者死于脑膜瘤疾病或最终复发，接受了再次手术或放疗。5年时复发或脑膜瘤相关死亡的风险为16.2%，可信区间[12.5, 20]，而5年总生存率为86.1%，可信区间[82.8, 89.6]。在竞争风险模型的多变量Fine-Gray回归中，静脉窦侵犯（风险比 = 1.8，可信区间[1.1, 2.9]，p = 0.028）、切除范围（风险比 = 0.2，可信区间[0.1, 0.3]，p < 0.001）和进展性脑膜瘤（风险比 = 7，可信区间[3.3, 14.8]，p < 0.001）被确定为特定病因死亡或脑膜瘤进展的独立预后因素。相比之下，诊断时年龄<65岁（风险比 = 1.1，可信区间[1, 1.1]，p < 0.001）和因脑膜瘤复发进行再次手术（风险比 = 2.6，可信区间[1.4, 5]，p = 0.00252）是总生存的预测因素。
在这个大型系列研究中，WHO I级脑膜瘤治疗失败与静脉窦侵犯、切除不完全和肿瘤进展相关；生存期较短与年龄增加和复发后再次手术相关。我们建议在WHO I级脑膜瘤研究中采用累积发病率竞争风险方法，因为在这些研究中无关死亡率可能很高，这种方法能更准确地估计疾病风险及相关预测因素。
