Details

Autor(en) / Beteiligte

• Islim, A I
• Mohan, M
• Moon, R
• Kolamunnage-Dona, R
• Rathi, N
• Mills, S J
• Brodbelt, A R
• Jenkinson, M D

Titel

OS4.1 A risk calculator to predict the need for an intervention within a patient’s estimated lifetime for incidentally-found asymptomatic meningiomas

Ist Teil von

• Neuro-oncology (Charlottesville, Va.), 2018-09, Vol.20 (suppl_3), p.iii222-iii222

Ort / Verlag

US: Oxford University Press

Erscheinungsjahr

2018

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Abstract Background 30% of newly-diagnosed meningiomas are incidental findings. There is no consensus on the optimal management. The aim of this study was to develop a risk calculator to enable identification of patients at risk of active monitoring failure who will require an intervention within their estimated lifetime. Material and Methods Active monitoring failure was defined as: new symptoms, MRI progression (absolute growth rate ≥ 2 cm3/year or absolute growth rate ≥ 1 cm3/year + relative growth rate ≥ 30%/year) or loss of treatment options. A prognostic model was developed using MRI and patient co-morbidity (age-adjusted Charlson index) in a retrospective cohort (2007–2015). Results 385 patients were included (403 meningiomas). Mean age at diagnosis was 62.6 years (SD= 12.0); 301 (78.2%) were female. Over a median of 36.0 months (range: 3–120), 1688 MRI were performed (mean=4 scans/patient). 44 (10.9%) meningiomas were classed as failed active monitoring; reasons being radiological progression (n=29), new symptom development (n=12), development or worsening of peritumoural oedema (n=12), meningioma volume exceeding 10 cm3 (n=9) and venous sinus invasion (n=7). Nineteen (43.2%) patients had > 1 reason for failing active monitoring. Median time to failure was 33.0 months (range: 5–102). Model parameters were based on statistical and clinical considerations. These included: increasing tumour volume (HR=2.17 [95% CI=1.53–3.09], p<0.001), peritumoural signal change (HR=1.58 [95% CI=0.65–3.85], p=0.313), FLAIR/T2 hyperintense meningiomas (HR=10.6 [95% CI=5.39–21.0], p<0.001) and proximity to critical neurovascular structures (HR=1.38 [95% CI=0.74–2.56], p=0.314). Discriminatory power of the model was excellent (Harrell’s C statistic=0.89). Patients were stratified based on the model into low, medium and high-risk groups. Low-risk patients had non-oedematous, small iso/hypointense meningiomas, distant from neurovascular structures. Rates of active monitoring failure at 5-years were 3%, 28% and 75% respectively. After 5-years of follow-up the probability of failed active monitoring plateaued in all risk groups. Older patients with co-morbidities (age-adjusted Charlson index ≥ 6) were 15-times more likely to die than to receive intervention at 5-years following diagnosis, regardless of risk-group. Conclusion Most meningiomas remain clinically and radiologically stable. Patients with Charlson index ≥ 6 do not require active monitoring. Low-risk patients require less frequent MRI monitoring. Follow-up beyond 5-years may not be required for all patients. Stratifying follow-up according to risk-group has the potential to reduce the cost of healthcare.