Department of Neurological Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
J Neurooncol. 2020 Sep;149(2):293-303. doi: 10.1007/s11060-020-03604-7. Epub 2020 Aug 28.
WHO grades II (atypical) and III (malignant) meningiomas are associated with significant morbidity and mortality. The role of adjuvant radiotherapy (RT) in management remains controversial. The goal of this study was to evaluate the impact of adjuvant RT on 5-year survival in patients with atypical and malignant meningiomas. We secondarily aimed to assess contemporary practice patterns and the impact of sociodemographic factors on outcome.
We queried the National Cancer Database for patients ≥ 18 years of age with cranial atypical or malignant meningiomas from 2010 through 2015 who underwent surgical resection with or without adjuvant radiotherapy. Subjects with unknown WHO grade or radiation status and those not receiving any surgical procedure were excluded from analysis.
The study includes 7486 patients, 6788 with atypical and 698 with malignant meningiomas. Overall 5-year survival was 76.9% (95% CI 75.5-78.3%) and 43.3% (95% CI 38.8-48.2%) among patients with WHO grades II and III meningiomas, respectively. Adjuvant RT correlated with improved survival in a multivariable model in patients with grade II tumors (HR 0.78; p = 0.029) regardless of the extent of resection. Age (HR 2.33; p < 0.001), male sex (HR 1.27; p < 0.001), Black race (HR 1.27; p = 0.011) and Charlson-Deyo Score ≥ 2 (1.35; p = 0.001) correlated with poorer survival whereas private insurance (HR 0.71; p < 0.001) correlated with improved survival. Adjuvant RT was also associated with improved 5-year survival among those with grade III tumors on univariate analysis (log-rank p = 0.006) but was underpowered for multivariable modeling. Utilization of adjuvant radiotherapy was only 28.4% and correlated with private insurance status. Academic institutions (25.3%) and comprehensive community cancer programs (21.4%) had lower radiotherapy utilization rates compared with integrated network cancer programs (30.5%) and community cancer programs (29.7%).
Adjuvant RT may correlate with improved overall survival in patients with grades II and III intracranial meningiomas regardless of the extent of resection. There is poor utilization of adjuvant RT for patients with grades II and III meningiomas likely due to a paucity of quality data on the subject. These findings will be strengthened with prospective data evaluating the role of adjuvant RT.
世界卫生组织（WHO）分级为 II 级（非典型）和 III 级（恶性）的脑膜瘤与较高的发病率和死亡率相关。辅助放疗（RT）在脑膜瘤治疗中的作用仍存在争议。本研究的目的是评估辅助 RT 对非典型和恶性脑膜瘤患者 5 年生存率的影响。我们的次要目标是评估当代的治疗模式以及社会人口因素对预后的影响。
我们从 2010 年至 2015 年在国家癌症数据库中查询了 18 岁以上接受过手术切除（伴或不伴辅助放疗）的颅内外典型或恶性脑膜瘤患者的数据。未明确 WHO 分级或放疗情况以及未接受任何手术治疗的患者均被排除在分析之外。
本研究共纳入 7486 例患者，其中 6788 例为非典型脑膜瘤患者，698 例为恶性脑膜瘤患者。在 WHO 分级为 II 级和 III 级的脑膜瘤患者中，5 年总体生存率分别为 76.9%（95%CI 75.5-78.3%）和 43.3%（95%CI 38.8-48.2%）。在多变量模型中，辅助 RT 与 II 级肿瘤患者的生存改善相关（HR 0.78；p=0.029），而与肿瘤切除范围无关。年龄（HR 2.33；p<0.001）、男性（HR 1.27；p<0.001）、黑种人（HR 1.27；p=0.011）和 Charlson-Deyo 评分≥2（HR 1.35；p=0.001）与生存率降低相关，而私人保险（HR 0.71；p<0.001）与生存率提高相关。在单变量分析中，辅助 RT 也与 III 级肿瘤患者的 5 年生存率改善相关（对数秩检验 p=0.006），但多变量模型的效能较低。辅助放疗的使用率仅为 28.4%，与私人保险状况相关。学术机构（25.3%）和综合性社区癌症项目（21.4%）的放疗使用率低于综合网络癌症项目（30.5%）和社区癌症项目（29.7%）。
辅助 RT 可能与 II 级和 III 级颅内脑膜瘤患者的总体生存率改善相关，而与肿瘤切除范围无关。对于 II 级和 III 级脑膜瘤患者，辅助 RT 的应用率较低，可能是由于缺乏该方面的高质量数据。随着前瞻性数据评估辅助 RT 的作用，这些发现将得到进一步证实。
