Intracranial WHO grade I meningioma: a competing risk analysis of progression and disease-specific survival
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%, 95%CI[12.5, 20], whereas 5-year overall survival was 86.1%, 95%CI[82.8, 89.6]. In the multivariable Fine-Gray regression for a competing risk model, venous sinus invasion (SHR = 1.8, 95%CI[1.1, 2.9], p0.028), extent of resection (SHR = 0.2, 95%CI[0.1, 0.3], p < 0.001), and progressing meningioma (SHR = 7, 95%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, 95%CI[1, 1.1], p < 0.001) and redo surgery for meningioma recurrence (HR = 2.6, 95%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.
KeywordsWHO grade I meningioma Recurrence Prognostic factors Outcome Competing risks
cumulative incidence competing risk
cumulative incidence function
competing risk regression
gross total resection
high power field
inter quartile range
subdistribution hazard ratio
sub total resection
World Health Organization
The authors thank the following person for their assistance: Janice Lafferty, Department of Neurosurgery; Dr. Andres Kulla, Elizabeth Fraser, Jacqueline MacPherson, Department of Neuropathology, Queen Elizabeth University Hospital, Glasgow; Melissa McEwan, Radiotherapy Department, The Beatson West of Scotland Cancer Centre, Glasgow; Thomas Alexander Gerds, Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
CC: conceived and designed the analysis/collected the data/performed the analysis/wrote the paper. DH: collected the data/revision of the work. LD: collected the data/revision of the work/final approval. MRR: conceived and designed the analysis/revision of the work/final approval.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent was not required.
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