Association of shorter time to surgery with improved overall survival for atypical intracranial meningiomas: an analysis using the National Cancer Database.
Linda Tang, Sachiv Chakravarti, Rohan Venkatdas, Emre Derin, A Karim Ahmed, Debraj Mukherjee
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引用次数: 0
Abstract
Objective: Atypical intracranial meningiomas are characterized by brain invasion and faster growth than lower-grade counterparts. Surgery improves survival for patients with atypical meningiomas, and this study assesses the association between the timing of surgery and survival.
Methods: Patients > 18 years of age with intracranial atypical meningiomas resected (2004-2019) and cataloged in the National Cancer Database were included. Descriptive statistics of sociodemographic and clinical characteristics were generated. Kaplan-Meier survival curves for each variable were generated. Cox proportional hazards models were developed to assess the association of time between diagnosis and surgery with overall survival, while controlling for age, sex, race, ethnicity, facility type, tumor size, comorbidity, resection type, adjuvant radiotherapy, and systemic therapy.
Results: A total of 5452 patients were included; 17.81% of the patients were between 18 and 50 years, 66.89% were between 51 and 75 years, and 15.30% were > 75 years. Among the cohort, 55.98% of patients were female. The average time between diagnosis and surgery was 0.8 months; 63.33% of the patients underwent gross-total resection, 28.28% received adjuvant radiotherapy, and 0.92% received systemic therapy. Overall, 21.39% of the patients died during the study period, and the average follow-up time after surgery was 50.9 months. Bivariate analysis showed that the risk of patient mortality over the entire study period increased significantly for every additional month between diagnosis and surgery (hazard ratio [HR] 1.03, 95% CI 1.01-1.06; p = 0.01). On multivariable analysis, a longer time between diagnosis and surgery (HR 1.03, 95% CI 1.00-1.05; p = 0.02) remained a significant predictor of mortality after adjusting for age, sex, race, ethnicity, treatment facility type, tumor size, frailty, resection type, adjuvant radiotherapy, and systemic therapy. On subgroup analysis, delayed time to surgery was associated with increased mortality for those who received subtotal resection (HR 1.04, 95% CI 1.01-1.07; p = 0.01), but not for those who received gross-total resection (HR 1.02, 95% CI 0.97-1.06; p = 0.43). Patients who were female, Asian, treated at an academic program, and received radiotherapy were associated with significantly decreased mortality, whereas patients who were male, African American, had a tumor size > 60 mm, had more comorbidities, and underwent subtotal resection experienced increased mortality.
Conclusions: Additional time between diagnosis and surgery is associated with an increased risk of mortality after adjusting for confounders. The authors recommend surgery as soon as safely possible after diagnosis for patients with intracranial meningiomas with signs of atypia.
期刊介绍:
The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.