Ashley Albert1, Anna Lee2, Toms Vengaloor Thomas3, Srinivasan Vijayakumar4. 1. Department of Radiation Oncology, University of Mississippi Medical Center, 350 W. Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA. Electronic address: aalbert@umc.edu. 2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 425 East 67th Street, NY 10065, USA. 3. Department of Radiation Oncology, University of Mississippi Medical Center, 350 W. Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA. Electronic address: tvthomas@umc.edu. 4. Department of Radiation Oncology, University of Mississippi Medical Center, 350 W. Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA. Electronic address: svijayakumar@umc.edu.
Abstract
PURPOSE: Older patients have inferior outcomes for meningioma and experience more post-operative complications. The purpose of this study was to identify national treatment patterns and outcomes based on age for benign meningiomas using the National Cancer Database (NCDB). MATERIAL AND METHODS: The NCDB was queried for patients with biopsy-proven World Health Organization Grade (WHO) grade I meningioma diagnosed between 2004 and 2015. Patients were stratified based on age: 18-50, 51-60, 61-70, 71-80, and > 80 years of age. Clinicodemographic details were compared via the Chi Square test. Multivariable logistic regression was used to determine factors associated with receipt of treatment and post-operative complications. Multivariable Cox regression and the Kaplan-Meier method were used to examine survival. RESULTS: 56,960 patients met inclusion criteria with a median follow-up of 48 months. Ages 61-70 (OR 0.73, 95% CI 0.62-0.85, p < .001), ages 71-80 (OR 0.51, 95% CI 0.43-0.60, p < .001), and age > 80 (0.16, 95% CI 0.14-0.19, p < .001) were less likely to receive treatment. Older age groups were associated with increased risk of post-operative complications and post-operative complications predicted for decreased survival. Treatment with surgery (HR 0.57, 95% CI 0.52-0.62, p < .001) and surgery and radiation (HR 0.59, 95% CI 0.50-0.70, p < .001) provided a survival benefit. Older age was associated with a survival decrement. CONCLUSIONS: Older patients are less likely to undergo treatment for benign meningioma and are more likely to have post-operative complications. Survival decreased with increasing age. Treatment improved survival among all patients. Risk-benefit ratio of treatment should be carefully considered when treating older patients with benign meningioma.
PURPOSE: Older patients have inferior outcomes for meningioma and experience more post-operative complications. The purpose of this study was to identify national treatment patterns and outcomes based on age for benign meningiomas using the National Cancer Database (NCDB). MATERIAL AND METHODS: The NCDB was queried for patients with biopsy-proven World Health Organization Grade (WHO) grade I meningioma diagnosed between 2004 and 2015. Patients were stratified based on age: 18-50, 51-60, 61-70, 71-80, and > 80 years of age. Clinicodemographic details were compared via the Chi Square test. Multivariable logistic regression was used to determine factors associated with receipt of treatment and post-operative complications. Multivariable Cox regression and the Kaplan-Meier method were used to examine survival. RESULTS: 56,960 patients met inclusion criteria with a median follow-up of 48 months. Ages 61-70 (OR 0.73, 95% CI 0.62-0.85, p < .001), ages 71-80 (OR 0.51, 95% CI 0.43-0.60, p < .001), and age > 80 (0.16, 95% CI 0.14-0.19, p < .001) were less likely to receive treatment. Older age groups were associated with increased risk of post-operative complications and post-operative complications predicted for decreased survival. Treatment with surgery (HR 0.57, 95% CI 0.52-0.62, p < .001) and surgery and radiation (HR 0.59, 95% CI 0.50-0.70, p < .001) provided a survival benefit. Older age was associated with a survival decrement. CONCLUSIONS: Older patients are less likely to undergo treatment for benign meningioma and are more likely to have post-operative complications. Survival decreased with increasing age. Treatment improved survival among all patients. Risk-benefit ratio of treatment should be carefully considered when treating older patients with benign meningioma.