Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
World Neurosurg. 2020 Sep;141:e133-e144. doi: 10.1016/j.wneu.2020.05.030. Epub 2020 May 11.
The role of adjuvant radiation after gross total resection (GTR) for grade II meningioma is evolving, prompting further evaluation in NRG-BN003, a phase 3 national trial. Furthermore, the relationship between facility volume and outcomes in patients with grade II meningioma after GTR has not been examined at a national level. We aim to assess overall survival (OS) of patients with grade II meningioma after GTR by surgical case volume and OS by receipt of adjuvant radiation.
We used the National Cancer Database to identity 2823 patients diagnosed with grade II meningioma who underwent GTR. Propensity score matching was applied to balance covariates in patients with grade II meningioma after GTR stratified by adjuvant radiation status. Multivariable logistic regression was used to assess factors associated with radiation receipt. Kaplan-Meier and log-rank tests were used to assess OS by facility volume.
As facility volume increased, OS increased, with a 5-year OS of 72.8% for facilities with GTR grade II meningioma volumes of ≤8 cases per decade and 87.5% for >8 cases per decade (P < 0.0001). There was no difference in 5-year OS between GTR alone and GTR with adjuvant radiation (84.8% vs. 86.4%; P = 0.151). Covariates significantly associated with radiation receipt included facility location, facility volume, distance, and tumor size.
Treatment at higher surgical case volume facilities is associated with improved OS for GTR grade II meningioma. These facilities also have more patients receiving adjuvant radiation. However, we observed no difference in OS between adjuvant radiation and surgery alone.
在大型全切除（GTR）后辅助放疗在 II 级脑膜瘤中的作用正在发展，这促使 NRG-BN003 进行了一项 3 期全国性试验。此外，在全国范围内尚未研究 II 级脑膜瘤 GTR 后设施量与结果之间的关系。我们旨在通过手术病例量评估 GTR 后 II 级脑膜瘤患者的总生存期（OS），并通过接受辅助放疗评估 OS。
我们使用国家癌症数据库来确定 2823 名接受 GTR 治疗的 II 级脑膜瘤患者。对 GTR 后接受辅助放疗的 II 级脑膜瘤患者按辅助放疗状态进行分层，应用倾向评分匹配来平衡协变量。多变量逻辑回归用于评估与放疗接受相关的因素。采用 Kaplan-Meier 和对数秩检验评估按设施量评估 OS。
随着设施量的增加，OS 增加，GTR II 级脑膜瘤每十年手术量≤8 例的设施 5 年 OS 为 72.8%，而每十年手术量>8 例的设施 5 年 OS 为 87.5%（P<0.0001）。GTR 单独与 GTR 加辅助放疗的 5 年 OS 无差异（84.8% vs. 86.4%；P=0.151）。与放疗接受显著相关的协变量包括设施位置、设施量、距离和肿瘤大小。
在手术病例量较高的设施中治疗与 GTR II 级脑膜瘤的 OS 改善相关。这些设施也有更多的患者接受辅助放疗。然而，我们观察到辅助放疗与单纯手术之间的 OS 无差异。
