Intracranial WHO grade I meningioma: a competing risk analysis of progression and disease-specific survival

Champeaux, Charles; Houston, David C.; Dunn, Lee; Resche‐Rigon, Matthieu

doi:10.1007/s00701-019-04096-9

Cited by 19 publications

(12 citation statements)

References 31 publications

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“…Outcome of patients treated for meningioma has been described as occasionally impaired with a 5-year OS of 80% all grades considered for Gennatas et al [ 21 ] and, 5-year OS ranging from 86% to 91.5% (95% CI 87.4–95.5) for benign meningioma [ 22 23 ]. Our 5-year OS rate of 89.7% (95% CI 84.6–95.1) compares favourably with other PT series with reporting 5-year OS rates between 53.2% to 100% ( Table 6 ).…”

Section: Discussionmentioning

confidence: 99%

Outcome After Protontherapy for Progression or Recurrence of Surgically Treated Meningioma

Champeaux-Depond

Weller

2021

Brain Tumor Res Treat

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Background To assess the outcome after meningioma surgery and protontherapy (PT). Methods We processed the French Système National des Données de Santé database to retrieve appropriate cases of meningiomas operated and irradiated between 2008 and 2017. Survival methods were implemented. Results One hundred ninety-three patients who received PT after meningioma surgery over a 10-year period were identified. Of the 193 patients, 75.6% were female. Median age at surgery was 50 years (interquartile range [IQR] 41–62). The median number of PT fractions was 31 (IQR 30–39) given over a median duration of 52 days (IQR 44–69). Fourteen patients (7.3%) also received photon radiotherapy and six patients (3.1%) stereotactic radiosurgery. Median follow-up was 4.4 years (IQR 3.86–4.71). Five-year progression-free survival (PFS) rate was 69% (95% confidence interval [CI] 62.1–76.6). For benign, atypical, and malignant meningioma, 5-year PFS rates were 71.5% (95% CI 64.4–79.4), 55.6% (95% CI 32.5–95), and 35.6% (95% CI 12.8–98.9), respectively ( p <0.01). In the adjusted regression, tumour location (hazard ratio [HR]=0.1, 95% CI 0.05–0.22, p <0.001), aggressive meningioma (HR=2.26, 95% CI 1.1–4.66, p =0.027), and the need of cerebrospinal fluid (CSF) insertion for hydrocephalus (HR=3.51, 95% CI 1.32–9.31, p =0.012) remained significantly associated to the PFS. All grades considered, 5-year overall survival (OS) rates was 89.7% (95% CI 84.6–95.1). For benign, atypical, and malignant meningioma, 5-year OS rates were 93% (95% CI 88.7–97.4), 76.4% (95% CI 51.4–100), and 44.4% (95% CI 16.7–100), respectively ( p <0.01). In the multivariable regression, an older age above 70 years (HR=5.95, 95% CI 2.09–16.89, p <0.001) associated to a high level of comorbidities (HR=5.31, 95% CI 1.43–19.78, p =0.013) and a malignant meningioma (HR=5.68, 95% CI 1.54–20.94, p =0.009) remained significantly associated to a reduced OS. Conclusion Five-year PFS and OS after meningioma surgery and PT is favourable but impaired for older patients with high level of morbidities, tumour of the convexity, malignant histopathology and for those requiring CSF shunting. Further inclusion and prolonged follow-up is required to assess other predictors such as sex, tumour volume, or given dose.

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Section: Discussionmentioning

confidence: 99%

Outcome After Protontherapy for Progression or Recurrence of Surgically Treated Meningioma

Champeaux-Depond

Weller

2021

Brain Tumor Res Treat

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“…In the postsurgical series, we selected 13 studies with follow-up data for incidence analysis 4 , 5 , 24 , 25 , 30 , 37–44 and another 2 studies with follow-up periods exceeding 5 years but unknown mean values for percentage analysis 22 , 45 ( Supplementary Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen postsurgical series reported 56 cases of malignant transformation among 2639 patients with WHO grade I meningiomas during a median follow-up period of 6 years (IQR = 5.7–8.1, Table 1 ). 4 , 5 , 24 , 25 , 30 , 37–44 IMT was 2.98/1000 patient-years (95% confidence interval [CI] = 1.9–4.3, test of heterogeneity: Q [ df = 12] = 19.46, P = .078, Figure 1A ). The funnel plot exhibited slight asymmetry without significance ( P = .063) in a linear regression test.…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, McGovern et al 24 reported that 8 tumors progressed to atypical or anaplastic lesions during recurrence among 175 benign tumors based on the WHO 2000 criteria. Yeon et al 25 and Champeaux et al 4 reported that 2.7% and 2.2% of benign meningiomas exhibited malignant progression based on the WHO 2016 criteria, respectively. It is unclear whether these differences are based on the differences of the pathological criteria or other factors such as changes in treatment modalities and the increased use of radiosurgery.…”

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Malignant transformation of WHO grade I meningiomas after surgery or radiosurgery: systematic review and meta-analysis of observational studies

Nakasu

Notsu

et al. 2020

Neuro-Oncology Advances

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Background The incidence and clinical features of the malignant transformation of benign meningiomas are poorly understood. This study examined the risk of the malignant transformation of benign meningiomas after surgery or stereotactic radiosurgery. Methods We systematically reviewed studies published between 1979 and 2019 using PubMed, Scoups, and other sources. We analyzed pooled data according to the PRISMA guideline to clarify the incidence rate of malignant transformation (IMT) and factors affecting malignant transformation in surgically or radiosurgically treated benign meningiomas. Results IMT was 2.98/1000 patient-years (95% confidence interval [CI] = 1.9–4.3] in 13 studies in a single-arm meta-analysis. Although the evidence level of the included studies was low, the heterogeneity of the incidence was mostly explained by the tumor location. In meta-regression analysis, skull base tumors had a significantly lower IMT than non-skull base tumors, but no gender association was observed. IMT after radiosurgery in nine studies was 0.50/1000 person-years (95% CI = 0.02–1.38). However, a higher proportion of skull base tumors, lower proportion of males, and lower salvage surgery rate were observed in the radiosurgery group than in the surgery group. The median time to malignant change was 5 years (interquartile range = 2.5–8.2), and the median survival after malignant transformation was 4.7 years (95% CI = 3.7–8) in individual case data. Conclusion IMT of benign meningioma was significantly affected by the tumor location. Radiosurgery did not appear to increase IMT, but exact comparisons were difficult because of differences in study populations.

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“…Hence, the new survival analysis concept has been published in several neurosurgical conditions such as meningioma, metastases, and cerebral aneurysms. 29 30 31 Additionally, multiple lesions of low-grade glioma were reported as a preventative factor of MT. 6 The findings may be an effect from competing events of patients with multiple lesions associated with poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Malignant Transformation of Astrocytoma: Competing Risk Regression Analysis

2022

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Background Malignant transformation (MT) of low-grade astrocytoma (LGA) triggers a poor prognosis in benign tumors. Currently, factors associated with MT of LGA have been inconclusive. The present study aims to explore the risk factors predicting LGA progressively differentiated to malignant astrocytoma. Methods The study design was a retrospective cohort study of medical record reviews of patients with LGA. Using the Fire and Gray method, the competing risk regression analysis was performed to identify factors associated with MT, using both univariate and multivariable analyses. Hence, the survival curves of the cumulative incidence of MT of each covariate were constructed following the final model. Results Ninety patients with LGA were included in the analysis, and MT was observed in 14.4% of cases in the present study. For MT, 53.8% of patients with MT transformed to glioblastoma, while 46.2% differentiated to anaplastic astrocytoma. Factors associated with MT included supratentorial tumor (subdistribution hazard ratio [SHR] 4.54, 95% confidence interval [CI] 1.08–19.10), midline shift > 1 cm (SHR 8.25, 95% CI 2.18–31.21), and nontotal resection as follows: subtotal resection (SHR 5.35, 95% CI 1.07–26.82), partial resection (SHR 10.90, 95% CI 3.13–37.90), and biopsy (SHR 11.10, 95% CI 2.88–42.52). Conclusion MT in patients with LGA significantly changed the natural history of the disease to an unfavorable prognosis. Analysis of patients' clinical characteristics from the present study identified supratentorial LGA, a midline shift more than 1 cm, and extent of resection as risk factors associated with MT. The more extent of resection would significantly help to decrease tumor burden and MT. In addition, future molecular research efforts are warranted to explain the pathogenesis of MT.

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Intracranial WHO grade I meningioma: a competing risk analysis of progression and disease-specific survival

Cited by 19 publications

References 31 publications

Outcome After Protontherapy for Progression or Recurrence of Surgically Treated Meningioma

Outcome After Protontherapy for Progression or Recurrence of Surgically Treated Meningioma

Malignant transformation of WHO grade I meningiomas after surgery or radiosurgery: systematic review and meta-analysis of observational studies

Risk Factors Associated with Malignant Transformation of Astrocytoma: Competing Risk Regression Analysis

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