Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, South 4th Ring West Road 119, Fengtai District, Beijing, 100070, People's Republic of China.
Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, South 4th Ring West Road 119, Fengtai District, Beijing, 100070, People's Republic of China.
Neurosurg Rev. 2023 Aug 9;46(1):196. doi: 10.1007/s10143-023-02103-3.
Controversies persist regarding the benefits of surgery in elderly patients with meningiomas. The objective of this study was to develop decision-making scale to clarify the necessity for surgical intervention and provide clinical consultation for this special population. This retrospective cohort study was conducted at a single center and included 478 elderly patients (≥ 65 years) who underwent meningioma resection. Follow-up was recorded to determine recurrence and mortality rates. Univariate and multivariate analyses were performed to identify significantly preoperative factors, and prognostic prediction models were developed with determined cutoff values for the prognostic index (PI). Model discrimination was evaluated using Kaplan-Meier curves based on the PI stratification, which categorized patients into low- and high-risk groups. A decision-making tree was then established based on the risk stratification from both models. Among all patients analyzed (n = 478), 62 (13.0%) experience recurrence and 47 (10.0%) died during the follow-up period. Significantly preoperative parameters from both models included advanced age, aCCI, recurrent tumor, motor cortex involvement, male sex, peritumoral edema, and tumor located in skull base (all P < 0.05). According to the classification of PI from the two models, the decision-making tree provided four recommendations that can be used for clinical consultation. Surgery is not recommended for patients assigned to the high-risk group in both models. Patients who meet the low-risk criteria in any model may undergo surgical intervention, but the final decision should depend on the surgeon's expertise.
关于老年脑膜瘤患者手术的益处仍存在争议。本研究的目的是制定决策量表，以明确手术干预的必要性，并为这一特殊人群提供临床咨询。这项回顾性队列研究在一家中心进行，共纳入 478 例接受脑膜瘤切除术的老年患者（≥65 岁）。记录随访以确定复发率和死亡率。进行单因素和多因素分析以确定显著的术前因素，并根据确定的预后指数（PI）截断值制定预后预测模型。使用基于 PI 分层的 Kaplan-Meier 曲线评估模型的区分能力，将患者分为低风险组和高风险组。然后根据两个模型的风险分层建立决策树。在所有分析的患者（n=478）中，62 例（13.0%）在随访期间复发，47 例（10.0%）死亡。两个模型中的显著术前参数均包括高龄、aCCI、复发性肿瘤、运动皮质受累、男性、瘤周水肿和颅底肿瘤（均 P<0.05）。根据两个模型的 PI 分类，决策树提供了四项可用于临床咨询的建议。对于两个模型中高风险组的患者不建议手术。符合任何模型中低风险标准的患者可以进行手术干预，但最终决策应取决于外科医生的专业知识。
