Eun Jung Lee1, Jin Hoon Park2, Eun Suk Park3, Jeong Hoon Kim4. 1. Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea. 2. Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea. 3. Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. 4. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: jhkim1@amc.seoul.kr.
Abstract
OBJECTIVE: To analyze factors affecting observation failure (Ob-F) of untreated intracranial meningiomas (IMs) and to develop a "wait-and-see" strategy for newly diagnosed IMs based on risk. METHODS: Factors affecting Ob-F (i.e., development of neurologic symptoms, significant growth, loss of opportunity to do radiosurgery, and tumor invasion into the adjacent sinus) were examined using a multivariate Cox proportional hazard model. The utility of the Asan Intracranial Meningiomas Scoring System (AIMSS) for screening out patients at risk for Ob-F was also analyzed. The "wait-and-see" strategy was based on the growth rate affecting the 5-year observation success (Ob-S) rate. RESULTS: Over 46.9 months, 77 of 232 patients (33.2%) experienced Ob-F. Larger tumors, preexisting neurologic symptoms, absence of calcification, and isointense/hyperintense signal were predictors of Ob-F. An AIMSS score of 4 for tumors <2.5 cm in diameter (P = 0.0002) and a score of 6 for tumors ≥2.5 to <4.0 cm in diameter screened out tumors at risk for Ob-F (P = 0.0023). Initial growth rates of ≥20%/year for tumors <2.5 cm (P < 0.0001) and ≥1 cm3/year for tumors ≥2.5 to <4.0 cm (P = 0.0019) were predictive of 5-year Ob-S rate; however, tumors ≥4 cm tended to experience Ob-F, regardless of score group or growth rate. CONCLUSIONS: The AIMSS is helpful for screening out IMs at risk for Ob-F at the time of diagnosis. The initial growth rate after follow-up predicts the risk of future Ob-F in small- to medium- sized IMs.
OBJECTIVE: To analyze factors affecting observation failure (Ob-F) of untreated intracranial meningiomas (IMs) and to develop a "wait-and-see" strategy for newly diagnosed IMs based on risk. METHODS: Factors affecting Ob-F (i.e., development of neurologic symptoms, significant growth, loss of opportunity to do radiosurgery, and tumor invasion into the adjacent sinus) were examined using a multivariate Cox proportional hazard model. The utility of the Asan Intracranial Meningiomas Scoring System (AIMSS) for screening out patients at risk for Ob-F was also analyzed. The "wait-and-see" strategy was based on the growth rate affecting the 5-year observation success (Ob-S) rate. RESULTS: Over 46.9 months, 77 of 232 patients (33.2%) experienced Ob-F. Larger tumors, preexisting neurologic symptoms, absence of calcification, and isointense/hyperintense signal were predictors of Ob-F. An AIMSS score of 4 for tumors <2.5 cm in diameter (P = 0.0002) and a score of 6 for tumors ≥2.5 to <4.0 cm in diameter screened out tumors at risk for Ob-F (P = 0.0023). Initial growth rates of ≥20%/year for tumors <2.5 cm (P < 0.0001) and ≥1 cm3/year for tumors ≥2.5 to <4.0 cm (P = 0.0019) were predictive of 5-year Ob-S rate; however, tumors ≥4 cm tended to experience Ob-F, regardless of score group or growth rate. CONCLUSIONS: The AIMSS is helpful for screening out IMs at risk for Ob-F at the time of diagnosis. The initial growth rate after follow-up predicts the risk of future Ob-F in small- to medium- sized IMs.
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