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

  • Original Article - Tumor - Meningioma
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Abbreviations

CI:

confidence interval

CICR:

cumulative incidence competing risk

CIF:

cumulative incidence function

CR:

competing risk

CRR:

competing risk regression

GTR:

gross total resection

HPF:

high power field

HR:

hazard ratio

IQR:

inter quartile range

KM:

Kaplan–Meier

OS:

overall survival

PFS:

progression-free survival

RT:

radiotherapy

SHR:

subdistribution hazard ratio

STR:

sub total resection

TR:

total resection

WHO:

World Health Organization

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Acknowledgments

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

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Authors and Affiliations

  1. Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK

    Charles Champeaux, Deborah Houston & Laurence Dunn

  2. INSERM U1153, Statistic and Epidemiologic Research Centre Sorbonne Paris Cite (CRESS), ECSTRA team, Universite Diderot - Paris 7, USPC, Paris, France

    Charles Champeaux & Matthieu Resche-Rigon

  3. Department of Neurosurgery, Lariboisière Hospital, 2, rue Ambroise-Paré, Cedex 10, 75475, Paris, France

    Charles Champeaux

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  1. Charles Champeaux
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  4. Matthieu Resche-Rigon
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Contributions

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.

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Correspondence to Charles Champeaux.

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The authors declare that they have no conflict of interest.

Ethical approval

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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Champeaux, C., Houston, D., Dunn, L. et al. Intracranial WHO grade I meningioma: a competing risk analysis of progression and disease-specific survival. Acta Neurochir 161, 2541–2549 (2019). https://doi.org/10.1007/s00701-019-04096-9

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  • DOI: https://doi.org/10.1007/s00701-019-04096-9

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