Postoperative Long-Term Independence Among the Elderly With Meningiomas: Function Evolution, Determinant Identification, and Prediction Model Development

Abstract

BackgroundMaintenance of postoperative long-term independence has value for older adults who undergo surgical procedures. However, independence has barely caught attention for the elderly with meningiomas. Preventing postoperative long-term independence decline in this population necessitates the identification of the factors related to this outcome and minimizing their implications. Therefore, we assessed the independence evolution and identified potential determinants and population.Materials and MethodsFrom 2010 to 2016, elderly meningioma patients (≥65 years old) undergoing operation at Beijing Tiantan Hospital were included in our study. The primary outcome was 3-year (i.e., long-term) postoperative independence measured by Karnofsky performance scale (KPS) score. We used univariate and multivariate analyses to determine the risk factors for postoperative long-term independence, and nomogram was established.ResultsA total of 470 patients were included eligibly. The distribution in each KPS was significantly different before and 3 years after resection (P < 0.001). Especially in patients with preoperative KPS 80 and 70, only 17.5 and 17.3% of the patients kept the same KPS after 3 years, and the remaining patients experienced significant polarization. The most common remaining symptom cluster correlated with postoperative long-term independence included fatigue (R = −0.795), memory impairment (R = −0.512), motor dysfunction (R = −0.636) and communication deficits (R = −0.501). Independent risk factors for postoperative long-term non-independence included: advanced age (70–74 vs. 65–69 OR: 2.631; 95% CI: 1.545–4.481 and ≥75 vs. 65–69 OR: 3.833; 95% CI: 1.667–8.812), recurrent meningioma (OR: 7.791; 95% CI: 3.202–18.954), location in the skull base (OR: 2.683; 95% CI: 1.383–5.205), tumor maximal diameter >6 cm (OR: 3.089; 95% CI: 1.471–6.488), nerves involved (OR: 3.144; 95% CI: 1.585–6.235), high risk of WHO grade and biological behavior (OR: 2.294; 95% CI: 1.193–4.408), recurrence during follow-up (OR: 10.296; 95% CI: 3.253–32.585), lower preoperative KPS (OR: 0.964; 95% CI: 0.938–0.991) and decreased KPS on discharge (OR: 0.967; 95% CI: 0.951–0.984) (P < 0.05). The discrimination and calibration of the nomogram revealed good predictive ability (C-index: 0.810).ConclusionElderly meningioma patients might present significant polarization trend in maintaining long-term independence after surgery. Our findings will be helpful for guiding surgical management for the elderly with meningioma and provide proposals for early functional rehabilitation.

Meningioma in the elderly

“… 64 , 67 Postoperative complications significantly influence survival and functional course in the elderly. 66 , 71 , 72 , 88 It is important to note that comorbidities, frailty, and poor baseline performance status may be stronger predictors of adverse events than age, 73 , 74 and age alone is often not associated with complications in multivariable models adjusted for these factors. 58 , 65 , 73 , 75 Poor preoperative functional status is also an important risk factor for further functional deterioration.…”

Disease-Based Prognostication: Neuro-Oncology

“…Nomograms utilize available prognosis factors, including patient demographics and biological factors including biomarkers. Multiple nomograms have been generated for patients with meningioma that aid in clinical prediction, including studies focused on postoperative long-term independence in elderly patients, 19 atypical meningioma survival, 20,21 WHO Grade II meningiomas, 22 and preoperative pathological grade predictions. 23 Jia and coworkers created a nomogram that has good accuracy and consistency.…”

Health-Related Quality of Life Outcomes in Meningioma Patients Based upon Tumor Location and Treatment Modality: A Systematic Review and Meta-Analysis

“…Historically, the Karnofsky Performance Scale (KPS) has been used to assess HRQoL in meningioma patients, with preoperative KPS scores predicting postoperative outcomes following resection [8][9][10][11]. Although a reliable tool to assess functional outcomes and physical quality of life, KPS is not a subjective tool and does not account for other factors of HRQoL including psychological and social well-being.…”