Association of shorter time to surgery with improved overall survival for atypical intracranial meningiomas: an analysis using the National Cancer Database.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY
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.

非典型颅内脑膜瘤手术时间缩短与总体生存率提高的关系:使用国家癌症数据库的分析。
目的:不典型颅内脑膜瘤具有侵袭大脑、生长速度快于低级别脑膜瘤的特点。手术可提高非典型脑膜瘤患者的生存率,本研究评估手术时机与生存率之间的关系。方法:纳入2004-2019年在国家癌症数据库中登记的年龄为> - 18岁的颅内非典型脑膜瘤切除术患者。对社会人口学和临床特征进行描述性统计。生成每个变量的Kaplan-Meier生存曲线。在控制年龄、性别、种族、民族、设施类型、肿瘤大小、合并症、切除类型、辅助放疗和全身治疗的同时,建立了Cox比例风险模型来评估诊断和手术之间的时间与总生存率的关系。结果:共纳入5452例患者;17.81%的患者年龄在18 ~ 50岁,66.89%的患者年龄在51 ~ 75岁,15.30%的患者年龄在50 ~ 75岁。在队列中,55.98%的患者为女性。从诊断到手术平均时间为0.8个月;63.33%的患者接受了总切除,28.28%的患者接受了辅助放疗,0.92%的患者接受了全身治疗。总体而言,21.39%的患者在研究期间死亡,术后平均随访时间为50.9个月。双变量分析显示,在整个研究期间,从诊断到手术之间每增加一个月,患者死亡风险显著增加(风险比[HR] 1.03, 95% CI 1.01-1.06;P = 0.01)。在多变量分析中,诊断和手术之间的时间较长(HR 1.03, 95% CI 1.00-1.05;P = 0.02)在调整了年龄、性别、种族、民族、治疗设施类型、肿瘤大小、虚弱、切除类型、辅助放疗和全身治疗等因素后,仍然是死亡率的重要预测因子。在亚组分析中,延迟手术时间与接受次全切除术的患者死亡率增加相关(HR 1.04, 95% CI 1.01-1.07;p = 0.01),但接受总切除的患者无明显差异(HR 1.02, 95% CI 0.97-1.06;P = 0.43)。女性,亚洲人,在学术项目中接受放疗的患者死亡率显著降低,而男性,非裔美国人,肿瘤大小为bbb60 mm,有更多合并症,接受次全切除术的患者死亡率增加。结论:在调整混杂因素后,诊断和手术之间的额外时间与死亡风险增加相关。作者建议对有异型体征的颅内脑膜瘤患者在诊断后尽快进行安全手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
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.
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