Monden Daniel, Raimann Florian J, Neef Vanessa, Dubinski Daniel, Gessler Florian, Keil Fee, Forster Marie-Thérèse, Ronellenfitsch Michael W, Harter Patrick N, Freiman Thomas M, Hattingen Elke, Seifert Volker, Senft Christian, Baumgarten Peter
Department of Neurosurgery, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany.
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60528 Frankfurt, Germany.
J Clin Med. 2021 Apr 22;10(9):1820. doi: 10.3390/jcm10091820.
Along with increasing average life expectancy, the number of elderly meningioma patients has grown proportionally. Our aim was to evaluate whether these specific patients benefit from surgery and to investigate a previously published score for decision-making in meningioma patients (SKALE). Of 421 patients who underwent primary intracranial meningioma resection between 2009 and 2015, 71 patients were ≥70 years of age. We compared clinical data including World Health Organization (WHO) grade, MIB-1 proliferation index, Karnofsky Performance Status Scale (KPS), progression free survival (PFS) and mortality rate between elderly and all other meningioma patients. Preoperative SKALE scores (Sex, KPS, ASA score, location and edema) were determined for elderly patients. SKALE ≥8 was set for dichotomization to determine any association with outcome parameters. In 71 elderly patients (male/female 37/34) all data were available. Postoperative KPS was significantly lower in elderly patients ( < 0.0001). Pulmonary complications including pneumonia (10% vs. 3.2%; = 0.0202) and pulmonary embolism (12.7% vs. 6%; = 0.0209) occurred more frequently in our elderly cohort. Analyses of the Kaplan Meier curves revealed differences in three-month (5.6% vs. 0.3%; = 0.0033), six-month (7% vs. 0.3%; = 0.0006) and one-year mortality (8.5% vs. 0.3%; < 0.0001) for elderly patients. Statistical analysis showed significant survival benefit in terms of one-year mortality for elderly patients with SKALE scores ≥8 (5.1 vs. 25%; = 0.0479). According to our data, elderly meningioma patients face higher postoperative morbidity and mortality than younger patients. However, resection is reasonable for selected patients, particularly when reaching a SKALE score ≥ 8.
随着平均预期寿命的增加，老年脑膜瘤患者的数量也相应增加。我们的目的是评估这些特定患者是否能从手术中获益，并研究先前发表的用于脑膜瘤患者决策的评分（SKALE）。在2009年至2015年间接受原发性颅内脑膜瘤切除术的421例患者中，71例年龄≥70岁。我们比较了包括世界卫生组织（WHO）分级、MIB-1增殖指数、卡诺夫斯基功能状态量表（KPS）、无进展生存期（PFS）和死亡率等临床数据，这些数据来自老年患者和所有其他脑膜瘤患者。为老年患者确定了术前SKALE评分（性别、KPS、美国麻醉医师协会（ASA）评分、位置和水肿）。将SKALE≥8设定为二分法，以确定与结局参数的任何关联。在71例老年患者（男/女37/34）中，所有数据均可用。老年患者术后KPS显著较低（<0.0001）。我们的老年队列中肺部并发症包括肺炎（10%对3.2%；P = 0.0202）和肺栓塞（12.7%对6%；P = 0.0209）的发生率更高。对Kaplan-Meier曲线的分析显示，老年患者在3个月（5.6%对0.3%；P = 0.0033）、6个月（7%对0.3%；P = 0.0006）和1年死亡率（8.5%对0.3%；P < 0.0001）方面存在差异。统计分析显示，SKALE评分≥8的老年患者在1年死亡率方面有显著的生存获益（5.1%对25%；P = 0.0479）。根据我们的数据，老年脑膜瘤患者术后的发病率和死亡率比年轻患者更高。然而，对于选定的患者，手术切除是合理的，特别是当SKALE评分≥8时。
