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Decision-making tree for surgical treatment in meningioma: a geriatric cohort study

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Abstract

Controversies persist regarding the benefits of surgery in elderly patients with meningiomas. The objective of this study was to develop decision-making scale to clarify the necessity for surgical intervention and provide clinical consultation for this special population. This retrospective cohort study was conducted at a single center and included 478 elderly patients (≥ 65 years) who underwent meningioma resection. Follow-up was recorded to determine recurrence and mortality rates. Univariate and multivariate analyses were performed to identify significantly preoperative factors, and prognostic prediction models were developed with determined cutoff values for the prognostic index (PI). Model discrimination was evaluated using Kaplan-Meier curves based on the PI stratification, which categorized patients into low- and high-risk groups. A decision-making tree was then established based on the risk stratification from both models. Among all patients analyzed (n = 478), 62 (13.0%) experience recurrence and 47 (10.0%) died during the follow-up period. Significantly preoperative parameters from both models included advanced age, aCCI, recurrent tumor, motor cortex involvement, male sex, peritumoral edema, and tumor located in skull base (all P < 0.05). According to the classification of PI from the two models, the decision-making tree provided four recommendations that can be used for clinical consultation. Surgery is not recommended for patients assigned to the high-risk group in both models. Patients who meet the low-risk criteria in any model may undergo surgical intervention, but the final decision should depend on the surgeon’s expertise.

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Funding

Dr Huawei Huang supported this work, granted by the National Natural Science Foundation of China (81801042), Beijing Hospital Authority Youth Programme (20190504) and Beijing Municipal Administration of Hospitals Incubating Program (PX2023021). Dr Guobin Zhang also supported this work, granted by Beijing Municipal Administration of Hospitals Incubating Program (PX2023018).

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  1. Haoyi Li and Dao Zheng contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, South 4th Ring West Road 119, Fengtai District, Beijing, 100070, People’s Republic of China

    Haoyi Li, Dao Zheng, Yonggang Wang, Yuzhe Ying, Dali Sui, Song Lin, Zhongli Jiang & Guobin Zhang

  2. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, South 4th Ring West Road 119, Fengtai District, Beijing, 100070, People’s Republic of China

    Huawei Huang

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  1. Haoyi Li
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Contributions

Conception and design: GZ and HL; data collection and assembly: HL, DZ, YY, ZJ, YW, SL, and DS; analysis and interpretation of data: HL, GZ, and HH; drafting the article: HL, GZ, and DZ; and critically revising the article: GZ, HH, and ZJ. All authors provided critical revisions to the manuscript for important intellectual content and approved the final manuscript.

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Correspondence to Huawei Huang or Guobin Zhang.

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This study was approval by Ethics Committee of Beijing Tiantan Hospital and was conducted in accordance with the principles of the declaration of Helsinki.

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Li, H., Zheng, D., Wang, Y. et al. Decision-making tree for surgical treatment in meningioma: a geriatric cohort study. Neurosurg Rev 46, 196 (2023). https://doi.org/10.1007/s10143-023-02103-3

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