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Incidence and survival of patients with mild, atypical and malignant meningomes in the United States from 2004 to 2018

Incidence and survival of patients with mild, atypical and malignant meningomes in the United States from 2004 to 2018

JUNGUO CAO, Weijia Yan, Guihong Li, Zhixin Zhan, Xinyu Hong, Hong Yan

 

NOTES OF THE ASSOCIATION:
-This study was done in the United States where it is possible to collect data on ethnicity (white, Hispanic, etc.) which is imposed because prohibited in France. However, it appeared to us that this study deserved to be translated, because it includes women with meningiomas due to drugs, and above all it is on a large population, and a certain epidemiological value.
-We notice (as often when it comes to meningiomas) that it is clear that the relationship between the IR of women and men was 2.1 and also increased with age, reaching 3.6 in the group of 45-49 year olds, without it being explained . Now, we now know that women have pissing meningiomas that men because of the progestins who induce them, and in the defined age group, since meningioma has slow growth in the majority of cases and that it takes a number of years to pose concern. Certain data from this study therefore validates the results found in France (Ansm, Epi-Phare, Sébastien Froelich, Charles Champeaux, Thibault Passeri).

 

Summary

Meningioma is the primary tumor of the most frequent central nervous system, and its incidence is increasing. A systematic epidemiological and clinical analysis is necessary to better estimate its impact on public health and understand its prognostic factors.

Data has been obtained from the surveillance database, Epidemiology, and End Results (SEER) from 2004 to 2018 for all types of age -free meningiomas. The incidence rates (IR) adjusted to age and 95 % confidence intervals were estimated according to sex, age, race, ethnicity and the location of the tumor.

Kaplan-Meier analysis and proportional risk models of multivariate cox were used to analyze overall survival (OS). The risk regression model competing with Fine-Gray has been used to analyze the specific survival of the cause.

The data of a total of 109,660 patients with meningioma were analyzed . The majority of patients were over the age of 60, and only 0.41% of patients were between 0 and 19 years old. Meningioma IRs were higher in women, blacks and non -Hispanic patients than in men, whites and Hispanics, and I have increased with age.

The relationship between IRs of women and men was 2.1 and also increased with age, reaching 3.6 in the 45-49 year old group. Older and male patients with all types of meningiomas, black patients with mild and atypical meningomes, and patients with atypical and larger meningomes of size had a more unfavorable prognosis.

For all types of meningiomas, surgical resection has improved survival.

Incidence rates and reported survival trends covered all demographic data and all meningioma subtypes. Advanced age, male sex, black breed and tumor size can be significant prognostic factors for meningiomas, and the resection of the tumor can considerably improve the survival of patients with meningiomas.

What's new ?

The incidence of meningioma, the primary tumor of the most frequent central nervous system, is increasing . A systematic epidemiological and clinical analysis is necessary to better estimate its impact on public health and understand its prognostic factors. Here, using the surveillance database, Epidemiology, and End Results (SEER) in the United States, the authors have made a systematic review of incidence and meningioma survival trends, covering all demographic data and all subtypes of tumors. Advanced age, male sex, black race and tumor size can be significant prognostic factors for meningioma cases, and the resection of the tumor can considerably improve the survival of patients with meningioma.

 

Abbreviations

 Aian

 Amerindians/natives of Alaska

 APC

 Annual percentage variation

 API

 Asian/island of the Pacific

 CIM-O-3

 International classification of diseases for oncology, third edition

 GTR

 Total gross resection

 HR

 Risk report

 IC

 Confidence interval

 IR

 incidence rate

 ns

 No surgery

 WHO

 World Health Organization

 OS

 Global survival

 RT

 Radiotherapy

 SNC

 Central nervous system

 Seer

 Surveillance, Epidemiology, and End Results

 SHR

 Risk report of sub-distribution

 Str

 Subtotal resection

 Timp3

 tissue inhibitor of metalloproteinase 3

 TP73

 tumor protein 73

 

1 introduction

Meningioma is the primary tumor of the most common central nervous system (SNC), representing 38.3 % of all types of SNC tumors and 54.5 % of SNC non-malignant tumors reported from 2013 to 2017 in the United States, with an incidence rate (IR) of 8.81 per 100,000 people-years 1 . Women are more likely to be affected by non-clever meningioma than men 1-5 . The meningiomas are mainly intracranial, and only about 10 % are spinal. 6-9 They are more frequent in the elderly, with a higher frequency in people over 65, 10 and rare in children, representing 0.4 % to 4.1 % of all infant tumors. 11 As the risk of meningioma increases considerably with age, the burden of health care linked to meningioma will continue to increase with the aging of the population.

Despite its prevalence as a SNC tumor, epidemiological studies on meningioma are rare compared to other types of SNC tumors . In addition, these studies are either limited to patients over 65, 12 or have only focused on the incidence of grade meningiomas of grade II and III of the World Health Organization (WHO), 13 or have only analyzed hospital cohorts or samples of patients selected in another way. 14-16 so far, none of them has covered wide demographic data or different subtypes of meningioma.

Studies have identified various prognostic factors associated with the prognosis of patients with meningiomas, including the characteristics of patients and treatment methods. 15, 17-27 in addition to the OMS rank, the age and extent of resection represent essential prognostic factors. 28 A multivariate analysis has shown that age <40 years, male sex, subtotal resection (STR) and a high mitotic index are all independently associated with shorter progression survival. 29 Other studies, however, reported that age was not associated with global survival (bone), but other factors, such as male sex, comorbidity status, neurological deficiencies and performance scales affected the prognosis. 17, 22, 24 Consequently, taking into account the poor prognosis of certain types of meningiomas and their increasing prevalence, a systematic epidemiological and clinical analysis remains necessary for neuro-oncologists and managers of health policies in order to better estimate its impact on public health, to understand its prognostic factors and to take measures accordingly.

The Surveillance Program, Epidemiology, and End Results (SEER) is a source of information authority on the impact and survival of cancer in the United States. 30 The Seer is currently collecting and published data on the impact and survival of cancer from cancer registers based on the population and covering around 48.0 % of the American population. 30 The cancer registers supported by the SEER report almost all the incident cases coded as in situ (non-clever) and invasive (clever; primary site only) according to the international classification of diseases for oncology, third edition (CIM-O-3). 30 They sought to document the best method of confirming a cancer diagnosis, including histopathology, radiology and clinical confirmation, as reported at any time in the patient's medical history. 30 In this study, we used the SEER register and carried out a complete analysis of the raw data of patients with meningioma collected from 2004 to 2018 in the United States. Our study provides an in-depth examination of the incidence and survival trends of all the subtypes of Meningioma in the population.

2 methods

2.1 Data collection

We used the SEER database ”Incidence-Seer Research Data, 18 registries Plus, Nov 2020 Sub (2000-2018)” to search for Méningioma case from 2004 to 2018 without age restriction. The benign and atypical SNC tumors having been identified in the SEER program since 2004, this year was chosen as a limit year. When defining the selection criteria (“selection” part of the SERSTAT software), we only selected clear or specific elements for demographic details (age, sex, race and ethnicity), clinical characteristics (location and size of the tumor) and the details of the treatment. The subjects whose elements were not specified or lacked, and which had no primary or first tumor were not included. Together, our selection criteria produced a cohort of 109,660 patients.

2.2 Variables and population analysis

The incidence rates (IR) adjusted to age and confidence intervals (CI) at 95 % were estimated for meningiomas from 2004 to 2018 depending on the patient's sex, his age, his race, his ethnic origin and the location of the tumor. Blessed meningiomas were identified according to the following seven CIM-3 codes: 9530/0, 9530/1, 9531/0, 9532/0, 9533/0, 9534/0 and 9537/0.

The atypical meningiomas were identified by the following two CIM-3 codes: 9538/1 and 9539/1. Maline meningiomas were identified by the following three CIM-3 codes: 9530/3, 9538/3 and 9539/3. We have divided all the subjects in age group on the basis of 5 -year intervals. The racial categories included the blacks, the whites, the Amerindians/natives of Alaska (Aian) and the Asians/island of the Pacific (API). The categories of ethnic group included Hispanics and non-HISPANICs. The cases of tumors located at the suprateoriel level (CIM-O-3 700, 702-714), infractoriel (716-717) and the spine (701, 720-721, 725) were analyzed. The unpertified and other categories were not included in IR comparisons.

The American population of 2000 is the standard population commonly used to calculate the rates adjusted according to age, so that the IRs adjusted according to age have been standardized to the American population of 2000 and reported per 100,000 inhabitants in our study. The IRs were calculated using Seerstat 8.4.0. To characterize the trends of the MENINGIOMS IRIGIES from 2004 to 2018, the annual percentage variation (APC) was calculated by the JoinPoint Program 4.6.0.0.0 software. The permutation test was carried out for APCs, the statistical significance was set at P <0.05, and only the APCs with significant differences were presented in the figures. All the figures were generated using Graphpad Prism 7.0.

2.3 Survival analysis

Survival analyzes have been carried out for all cases of meningiomas reported from 2004 to 2018 depending on sex, age, race, ethnicity, the location of the tumor, the size of the tumor, the treatment method. The categories of sex, race, ethnicity and location of the tumor were the same for IR analysis. We used five age groups (0-19 years, 20-39 years, 40-59 years, 60-79 years and 80+ years) and two groups of tumor size (<3 cm and ≥3 cm).

The treatment modality has been grouped according to the coding guidelines specific to the SEER site in the following five subgroups: no treatment (NO), STR, Total gross resection (GTR), STR + Radiotherapy (RT) and GTR + RT. Due to the limited size of the samples, the AIAN and infractoring meningiomas have been excluded from survival analyzes for atypical and clever meningomes. To calculate the SG in separate groups, the Kaplan-Meier model was used in our study, and the differences between the groups were examined using the Log-Rank test.

To study the independent prognostic factors associated with SG, proportional risk models of multivariate COX have been used to determine risk reports (RR) and 95 %CI. For the analysis of competing risks, the cumulative impact of deaths linked to the tumor was calculated for each factor after taking into account the deaths of other causes. The Risk Risk Regression model of Fine-Gray has been used to estimate the risk of sub-distribution (RDS) and 95 %CI report. P <0.05 was considered statistically significant. IBM SPSS Statistics 25 software, R Statistical Software and SAS Software have been used for data analysis.

3 results

3.1 Patient characteristics of patients

The data of 109,660 patients in total were analyzed.

Table 1 presents the basic characteristics and the results of the treatment of these patients.

We found that 95.4% of patients had mild meningiomas, 3.6% of atypical meningiomas and 1.0% of malignant meningiomas.

Among the meningiomas whose grade WHO was documented (7,740 cases), 79.4% of the meningiomas were grade I of WHO, 18.7% of Grade II of WHO and 1.9% of Grade III of WHO. The largest age group was that of the 60-79 year olds, with 48,856 (44.6 %) patients, followed by that of 40-59 year olds with 31,586 (28.8 %) patients and that of 80 years and over with 22,487 (20.5 %) patients.

Women were more numerous than men (81,192 women, 74.04 %; 28,468 men, 25.96 %), with a women/men's report of 2.85:1.

It is interesting to note that this relationship varies between patients with tumors of different OMS grades: 2.98: 1 for grade I, 1.33: 1 for grade II and 1.26: 1 for grade III.

The majority of patients were white (87,188, 79.5 %), followed by blacks (12,872, 11.7 %) and APIs (8867, 8.1 %). Overall, 89.1 % of patients (97,649) were non -Hispanic. Regarding the location of the tumor, most of the cases were supratotory (105,314, 96.0 %).

Most benign tumors were of a size <3 cm (60,989, 70.5%), but most of the atypical (2779, 84.7%) and malignant tumors (626, 77.9%) were ≥3 cm.

Most patients with benign tumors have not undergone surgical treatment or RT (69,079, 66.04%), while most patients with atypical and malignant tumors have undergone surgery (atypical: 3459, 88.1%; malignant: 834, 73.5%). In addition, 23.3 % of patients with atypical meningioma and 32.4 % of patients with clever meningioma have carried out surgery and RT.

 

 

Table 1. Basic characteristics of patients

Benign Atypical Clever Total
Number % Number % Number % Number %
Total 109 660 104 596 95.38 3927 3.58 1137 1.04 109 660 100
Age 00-19 y 379 0.36 61 1.55 14 1.23 454 0.41
20–39 y 5743 5.49 443 11.28 91 8.00 6277 5.72
40–59 y 29 892 28.58 1379 35.12 315 27.70 31 586 28.80
60–79 y 46 602 44.55 1728 44.00 526 46.26 48 856 44.55
80+ y 21 980 21.01 316 8.05 191 16.80 22 487 20.51
Sex Women 78 318 74.88 2239 57.02 635 55.85 81 192 74.04
Man 26 278 25.12 1688 42.98 502 44.15 28 468 25.96
Breed White 83 442 79.78 2923 74.43 823 72.38 87 188 79.51
Black 12 141 11.61 553 14.08 178 15.66 12 872 11.74
Aian 705 0.67 21 0.53 7 0.62 733 0.67
API 8308 7.94 430 10.95 129 11.35 8867 8.09
Ethnicity Hispanic 11 426 10.92 434 11.05 151 13.28 12 011 10.95
Non-hispanic 93 170 89.08 3493 88.95 986 86.72 97 649 89.05
Site Supratoire 100 398 95.99 3820 97.28 1096 96.39 105 314 96.04
Infractor 51 0.05 2 0.05 6 0.53 59 0.05
Spinal 4147 3.96 105 2.67 35 3.08 4287 3.91
Size <3 cm 73 688 70.45 601 15.30 251 22.14 61 669 68.02
≥3 cm 30 908 29.55 3326 84.70 886 77.86 28 992 31.98
Treatment No 69 075 66.04 467 11.88 301 26.47 69 845 63.69
Str 13 211 12.63 905 23.05 180 15.86 14 298 13.04
Gtr 20 103 19.22 1641 41.78 287 25.26 22 027 20.09
Str + RT 1193 1.14 384 9.79 138 12.11 1718 1.57
GTR + RT 1004 0.96 530 13.50 231 20.30 1765 1.61

 

3.2 Incidence of mild, atypical and malignant meningiomas from 2004 to 2018

3.2.1 ACCIPTION BY AGE AND SEX

The IR adjusted according to age for the different types of meningiomas from 2004 to 2018 are presented in Figure 1. For mild meningiomas, the IR increased significantly with each age group of 5 years, going from 0.11 cases per 100,000 inhabitants (95 % CI: 0.06-0.26) at the age of 0-19 to 64.28 cases for 100,000 : 62. 56-66.15) at the age of 85 and over in women, and 0.10 cases per 100,000 inhabitants (95 % CI: 0.06-0.24) at the age of 0-19 years at 39.71 cases per 100,000 (95 % CI: 37.85-41.88) at the age of 85 and over in men (Figure 1A). For atypical meningioma, IRs in women and men increased with age, then reached a peak before gradually decreasing. The maximum IRs were 1.35 cases per 100,000 (95 % CI: 1.16-1.55) in women in the group of 70-74 year olds and 1.28 cases per 100,000 (95 % CI: 1.06-1.55) in men in the group of 75-79 year olds (Figure 1C). For malignant meningiomas, the IR has increased significantly for each age group, from 0.006 cases per 100,000 in the population aged 0 to 19 years (95 % CI: 0.001-0.057) to 0.539 cases per 100,000 (95 % CI: 0.391-0.789) in the 85 and over group. The IR of women and men were both of more than 0.2 cases per 100,000 beyond 60 years (Figure 1e). The IR women/men ratio for mild meningiomas increased with age, reaching a maximum ratio of 3.6 in the 45-49 year old group, then decreased with age (Figure 1G). Unlike Benin Méningioma, IRs for atypical and clever meningomes did not differ significantly by sex for any age group of 5 years.

 

Figure 1

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Import rate adjusted according to age (IR) and annual variations in percentage (APC) by age and by sex. Rate of incidence by sex and age interval of 5 years (A, C and E), annual variations as a percentage per sex from 2004 to 2018 (B, D and F). (A and b) Benin meningioma; (C and d) atypical meningioma; (E and F) Malinan meningioma. (G) Curve of the women's/men report as a function of age. *Only APCs which are significantly different at the level P <0.05 are indicated.

In men as in women, a significant increase in mild meningiomas was observed between 2004 and 2009 (female APC: 5.5 % [95 % CI: 3.9-7.2], p <0.001; male APC: 5.6 % [95 % CI: 3.6-7.6], p <0.001; Figure 1b). However, from 2009 to 2018, the growth rate slowed down (female APC: 1.1 % [95 % CI: 1.8-3.9], p = 0.003; Male APC: 0.9 % [95 % CI: 1.7-2.6], p = 0.028; Figure 1b). For atypical meningioma from 2004 to 2018, IR in women continued to increase significantly (APC: 5.6 % [95 % CI: 4.6-6.6], p <0.001). IR in men showed a similar trend from 2004 to 2018 (APC: 4.2% [95% CI: 3.2-5.3], p <0.001; Figure 1D). For malignant meningioma, IR in women showed a significant decrease from 2004 to 2018 (APC: -4.7% [95% CI: -7.1 to -2.3], p = 0.001; Figure 1F). In men, the incidence has also shown a downward trend, but the decrease was not statistically significant (Figure 1F).

3.2.2 Import by age and race

For mild meningiomas, the overall IR was significantly higher for the black population (20.81 cases per 100,000 [95% CI: 19.59-22.08]) than for all other breeds, while the overall incidence for the Aian population was significantly lower than for all other races (11.13 cases per 100,000 [95%: 8.46-14.45]; 2a). As for mild meningiomas, marginal and clever meningiomas IR were also significantly higher for the black population (marginal: 0.81 cases per 100,000 [95 % CI: 0.59-1.09]; clever: 0.33 cases per 100,000 [95 % CI: 0.19-0.53] that in the white population (atypical cases: 0.56 cases 000 [95 % CI: 0.50-0.64];

Figure 2

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Import rate adjusted according to age (IR) and annual variations in percentage (APC) by age and breed. Rate of incidence by race and by age interval of 5 years (A, C and E), annual variation in percentage per race from 2004 to 2018 (B, D and F). (A and b) Benin meningioma; (C and d) atypical meningioma; (E and F) Malinan meningioma. The breeds include whites, blacks, America Indians and Alaska (Aian) Alagius, as well as the Asians and islanders of the Pacific (API). *Only appear the APCs which are significantly different at the level p <0.05.

 

For mild meningiomas from 2004 to 2009, the incidence increased significantly for black and white populations (black: APC: 5.7 % [95 % CI: 3.7-7.8], p <0.001; White: APC: 5.6 % [95 % CI: 3.7-7.5], p <0.001). From 2009 to 2018, the IR continued to increase, but the increase rate has slowed down in the white population (white: APC: 1.0 % [95 % CI: 0.2-1.7], p = 0.014). For the AIAN and API populations, the IR increased significantly between 2004 and 2018 (AIAN: APC: 3.1% [95% CI: 0.9-5.3], p = 0.009; API: APC: 1.2% [95% CI: 0.5-2.0], p = 0.004; Figure 2b). For atypical meningiomas, the IRs of the white, black and API populations increased significantly between 2004 and 2018 (white: APC: 4.9 % [95 % CI: 4.3-5.5], p <0.001; black: APC: 6.0 % [95 % CI: 3.5-8.6], p <0.001; API: APC: 2.4 % 0.5-4.3], p = 0.017; On the other hand, the IR of maline meningomes decreased significantly during the same period for the white and black populations (white: -2.9 % [95 % CI: -4.8 to -0.9], p = 0.008; black: APC: -7.4 % [95 % CI: -10.8 to -3.9], p = 0.001) has shown a downward but statistically non -significant trend (Figure 2F).

 

3.2.3 Import by age and ethnic origin

For mild meningiomas, the overall IR was significantly higher in the non-Hispanic population (18.21 cases per 100,000 [95 % CI: 17.85-18.59]) than in the Hispanic population (15.13 cases per 100,000 [95 % CI: 14.21-16.11]; Figure 3A). As for Benin meningioma, IRs for atypical and malignant meningomes were significantly higher in the non-hispanic population (atypical: 0.61 cases per 100,000 [95 % CI: 0.55-0.69]; clever: 0.21 cases per 100,000 [95 %: 0.17-0.25])) than in the Spanish population ( 0.46 cases for 100,000 [95 % CI: 0.32-0.65];

Figure 3

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Introductory rate adjusted according to age (IR) and annual variations in percentage (APC) by age and by ethnicity. Impact rate by ethnic origin and by age 5 years (A, C and E), annual variations in percentage per ethnic origin between 2004 and 2018 (B, D and F). (A and b) Benin meningioma; (C and d) atypical meningioma; (E and F) Malinan meningioma. *Only appear the APCs which are significantly different at the level p <0.05.

From 2004 to 2009, the IR of mild meningomes increased significantly in the non-Hispanic population (APC: 5.5 % [95 % CI: 3.9-7.1], p <0.001), and the trend continued from 2009 to 2018 (APC: 0.9 % [95 % CI: 0.3-1.6], p = 0.007). As in the non-Hispanic population, the IR of mild meningomes in the Hispanic population also increased significantly between 2004 and 2018 (APC: 1.6% [95% CI: 0.6-2.6], p = 0.003; Figure 3b). For atypical meningioma, IRs in non-Hispanic and Hispanic groups increased significantly between 2004 and 2018 (non-Hispanic: APC: 5.4 % [95 % CI: 4.8-6.1], p <0.001; Hispanic: APC: 1.7 % [95 %: 0.3-3.0], p = 0.02; For malignant meningioma, IR significantly decreased between 2004 and 2018 in the non -Hispanic population (APC: -4.3 % [95 % CI: -6.1 to -2.4], p <0.001), but not in the Hispanic population (Figure 3F).

3.2.4 Age incidence and location of the tumor

Regarding the location of tumors, most of them were located in the supratotory region (105,314, 96.0 %).

Some were located in the spinal region (4,287, 3.9 %), and meningiomas in the infractoric regions represented less than 0.1 % of all cases.

For mild and clever solemn and clever meningiomas, the IRs increased significantly with each age group of 5 years and reached maximum values ​​at the age of 85 and over (mild: 54.62 cases per 100,000 [95 % CI: 53.28-56.06]; clever: 0.53 cases per 100,000 [95 % CI: 0.40-0.78];

For atypical supratotory meningiomal, the IR increased to reach a peak at 70-74 years (0.64 cases per 100,000 [95 % CI: 0.52-0.88]), then gradually decreased (Figure 4C). For spinal meningiomas, the IRs of the three types of meningiomas increased with age, then decreased after reaching a peak. The maximum age groups varied, however (80-84 years for mild meningiomas, 75-79 years for atypical meningiomas and 70-74 years for clever meningiomas; Figure 4A, C, E).

Figure 4

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Import rate adjusted according to age (IR) and annual variations in percentage (APC) by age and tumor location. Rate of incidence by tumor location and by age interval of 5 years (A, C and E), annual variations in percentage by tumor location between 2004 and 2018 (B, D and F). (A and b) Benin meningioma; (C and d) atypical meningioma; (E and F) Malinan meningioma. Location of tumors, including supratoire, infractoring and spinal. *Only the APCs significantly different at the level P <0.05 are indicated.

From 2004 to 2009, the IR of Benine Supratentory Meningiomas increased significantly (APC: 5.6 % [95 % CI: 4.0-7.3], p <0.001), and it continued to increase significantly from 2009 to 2018 (APC: 0.8 % [95 % CI: 0.2-1.4], p = 0.02). On the other hand, the IR of infractoring meningomes decreased significantly between 2004 and 2018 (APC: -10.7 % [95 % CI: -17.2 to -3.6], p = 0.007; Figure 4b). As for the Benin supratentoriel meningiomal, the IR of atypical meningioma increased significantly between 2004 and 2008 (APC: 6.2% [95% CI: 2.3-10.3], p = 0.005) as well as between 2008 and 2018 (APC: 4.4% [95% CI: 3.4-5.4], p <0.001; Figure 4D). Unlike the IRI of the Bless and atypical Srutentory Meningiomes, the IR of the Maline Meningiomas decreased significantly between 2004 and 2018 (APC: -3.3 % [95 % CI: -5.1 to -1.5], p = 0.002; Figure 4F).

3.3 SG patients with benign, atypical and clever meningioma depending on age, sex, race, ethnicity, the location of the tumor, the size of the tumor and the treatment modality from 2004 to 2018.

3.3.1 SG by Kaplan-Meier analysis

Kaplan-Meier's analysis has shown significant differences in SG for mild meningiomas depending on age (p <0.0001), sex (p <0.0001), breed (p <0.0001), ethnic origin (p <0.0001), the location of the tumor (p <0.0001) and the treatment method (p <0,0001), but the size of the tumor had little effect on the SG (Figure 5A). For atypical meningioma, significant differences in SG have been observed according to age (p <0.0001), sex (p = 0.0140), breed (p = 0.0128), the size of the tumor (p <0.0001) and the treatment modality (p = 0.0003), but not ethnic origin (figure 5b). For malignant meningiomas, significant differences in SG have been observed according to age (p <0.0001), sex (p = 0.0083), ethnic origin (p = 0.0183), the size of the tumor (p = 0.0037) and the treatment mode (p = 0.0004). Median survivors and 95 % CIs of each group are presented in additional table 1.

Figure 5

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Kaplan-Meier analysis as a function of age, sex, race, ethnic origin, the location of the tumor, its size and the treatment modality. (A) Benin meningioma; (B) atypical meningioma; (C) Malinous meningioma. *Only the significant differences in overall survival are indicated at the level p <0.05.

3.3.2 Factors associated with the SG according to the proportional multivariable risk models of COX

Then, we studied associations between clinical and demographic variables and SG patients with benign, atypical and malignant meningomes using multivariate regression models with proportional Risk of COX (Figure 6b and additional table 1). After controlling the various factors, the model showed that the following factors had a significant impact on SG in patients with benign meningomes: age, sex, race, ethnic origin, the location of the tumor, the size of the tumor and the treatment modality (Figure 6b and additional table 1). The risk of death is multiplied by 3.35 for each increase of 20 years of the patient's age (HR: 3.35 [95 % CI: 3.29-3.41], p <0.001). The risk of death is 41.3 % higher in men than in women (HR: 1.41 [95 % CI: 1.38-1.45], p <0.001). Black patients had a risk of mortality 27.4 % higher (HR: 1.27 [95 % CI: 1.23-1.32], p <0.001) that white patients, but the API population had a risk of mortality 13.3 % lower (HR: 0.87 [95 % CI: 0.83-0.91], p <0.001) than white patients. Compared to Hispanic patients, non-Hispanic patients presented a risk of mortality higher by 10.6 % (HR: 1.11 [95 % CI: 1.06-1.56], p <0.001). Patients with a spinal tumor had a risk of death of 15.2 % (HR: 0.85 [95 % CI: 0.79-0.91], p <0.001) compared to patients with suprateoral tumor. Patients with large tumor (≥3 cm) had a 39.2 % higher risk of death (HR: 1.39 [95 % CI: 1.35-1.43], p <0.001) that patients with a small tumor (<3 cm). The Str and GTR operations have reduced the risk of death by 59.5 % and 62.0 %, respectively (Str: HR: 0.41 [95 % CI: 0.39-0.42], p <0.001; GTR: HR: 0.38 [95 % CI: 0.37-0.39], p <0.001). In addition, Str + RT and GTR + RT reduced the risk of death by 64.5 % and 59.4 %, respectively (Str + RT: HR: 0.36 [95 % CI: 0.31-0.41], p <0.001; GTR + RT: HR: 0.41 [95 %: 0.36-0.46], p <0.001).

Figure 6

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Cumulative impact curves and risk reports for each of the characteristics of the survival model. (A) Cumulative impact curves according to age, sex, size of the tumor and the treatment modality for clever meningioma; (B) Survival analysis by multivariable cox regression for Benin, atypical and clever meningioma; (C) Survival analysis by regression of the risk competing for malignant meningioma. *Represents significant differences at the level p <0.05.

 

For atypical meningioma, age, sex, race, ethnic origin, the location of the tumor, the size of the tumor and the treatment modality had a significant effect on the SG according to the model (Figure 6b and additional table 1). The risk of death is multiplied by 2.78 for each increase of 20 years of the patient's age (HR: 2.78 [95 % CI: 2.53-3.05], p <0.001). Men had a risk of death higher by 14.3 % (HR: 1.14 [95 % CI: 1.00-1.30], p = 0.045) to that of women. Black patients had a 58.2 % higher risk of death (HR: 1.58 [95 % CI: 1.32-1.90], p <0.001) than white patients. Compared to Hispanic patients, non-Hispanic patients had a lower death risk of 28.0 % (HR: 0.720 [95 % CI: 0.580-0.893], p = 0.003). The location of the spinal tumor was associated with a risk of death lower by 47.9 % compared to the location of the supratotory tumor (HR: 0.52 [95 % CI: 0.28-0.98], p = 0.043). Patients with large tumor (≥3 cm) had a 43.9 % higher risk of death (HR: 1.44 [95 % CI: 1.13-1.84], p = 0.004) that patients with a small tumor (<3 cm). The Str and GTR operations reduced the risk of death by 16.0 % and 29.8 %, respectively (STR: HR: 0.84 [95 % CI: 0.71-1.00], p = 0.047; GTR: HR: 0.70 [95 % CI: 0.60-0.82], p <0.001). In addition, STR + RT and GTR + RT reduced the risk of death by 40.0 % and 34.5 %, respectively (STR + RT: HR: 0.60 [95 % CI: 0.47-0.77], p <0.001; GTR + RT: HR: 0.66 [95 %: 0.53-0.81].

The age, sex, size of the tumor and the treatment modality significantly affect the SG of patients with clever meningioma, but the race, the ethnic origin and the location of the tumor have little effect (Figure 6b and additional table 1). The risk of death is multiplied by 2.06 for each increase of 20 years of the patient's age (HR: 2.06 [95 % CI: 1.85-2.28], p <0.001). The risk of death is 36.4 % higher in men (HR: 1.36 [95 % CI: 1.53-1.61], p <0.001) than in women. Patients with large tumor (≥3 cm) had a 40.6 % higher risk of death (HR: 1.41 [95 % CI: 1.07-1.85], p = 0.014) than those with a small tumor (<3 cm). Patients who underwent a STR or GTR had a risk of death lower than 31.1 % or 43.8 % (STR: HR: 0.69 [95 % CI: 0.54-0.88], p = 0.003; GTR: HR: 0.56 [95 % CI: 0.51-0.77], p <0.001) to those who have not received treatment. In addition, the GTR + RT association reduced the risk of death by 26.9 % (GTR + RT: HR: 0.73 [95 % CI: 0.59-0.91], p = 0.004).

3.4 Specific survival of the cause of patients with clever meningioma depending on age, sex, race, ethnic origin, location of the tumor, its size and treatment modality from 2004 to 2018

At the time of data collection, 446 patients with clever meningioma (39.2%) died from their meningioma, and no patient with Benin or atypical meningioma was recorded as deceased due to meningioma. We carried out an analysis of the cumulative impact of deaths linked to meningioma and deaths of other causes, the results showed that there was an obvious difference (additional figure 1A). In addition, the cumulative risk of death linked to malignant meningioma at 1 year, 5 years and 10 years respectively was 14.2% [95% CI: 12.2-16.4], 33.7% [95% CI: 30.7-36.9] and 40.1% [95%: 36.6-43.7]. For malignant meningiomas, significant differences in the survival specific to the case were observed according to age (p <0.0001), sex (p = 0.015), the size of the tumor (p <0.0001) and the treatment modality (p = 0.0027).

The SHRs of the risk of death linked to meningioma after analysis of the competitive risk are presented in Figure 6C and the additional table 2. In the regression of the risk competitor of Fine-Gray for specific survival to the cause of meningioma, the following factors have had a significant impact on specific survival in the cause in patients with malignant meningioma: age, sex tumor and treatment modality. The risk of death increases by 14% for each increase of 20 years of the patient's age (HR: 1.14 [95% CI: 1.11-1,18], p <.001). The risk of death is 26.5 % higher in men than in women (HR: 1.27 [95 % CI: 1.17-1.36], p = 0.015). Patients with large tumor (≥3 cm) had a risk of death 2.09 times higher (HR: 2.09 [95 % CI: 1.40-2.94], p = 0.002) that patients with a small tumor (<3 cm). It is interesting to note that patients having undergone a STR + RT had a risk of death 51.1 % higher (STR + RT: HR: 1.51 [95 % CI: 1.35-1.67], p = 0.001) than those who have not received surgical treatment or radiotherapy.

4 discussion

4.1 Incidence

In our study, we analyzed the data of a total of 109,660 patients and found that 95.4 % of patients had Benin meningioma, 3.6 % atypical meningioma and 1.0 % malignant meningioma, which corresponds to previous reports 16, 31 Quinn et al have described 159,038 patients with meningioma in the United States between 2013 and 2017, Percentages of non -clever and clever meningiomas were similar to those of our study (157,288 [98.9 %] non -clever and 1,750 [1.1 %] clever). 1 In particular, our study and that of Quinn et al have both used the codes of CIM-OO-3 to define meningioma, which differs from the classification of the WHO which was widely used in literature 1 . Among the meningiomas with an OMS grade documented in our study, 79.4% of the meningiomas were grade I of WHO, 18.7% of Grade II of the WHO and 1.9% of Grade III of WHO. Consequently, it is essential to pay attention to disparities in epidemiological data on meningiomas produced according to different standards, and it is urgent that scientists create a coherent and reliable standard of categorization for meningiomas.

We found that IRs increased with age and that the majority of patients were over 60, which indicates that age can be a risk factor for meningioma. Recently, studies have highlighted epigenetic mechanisms, such as the modification of DNA methylation schemes in cancer, which could explain the higher frequency of meningiomas in the elderly.16, 32-35

In addition, we have found that the report of the IRs of the meningomes between women and men was 2.1: 1 and that it increased with age, reaching a peak of 3.6 in the group of 45-49 year olds, then decreasing in older populations (Figure 1G). However, in all age groups of 5 years, the IRs of atypical and malignant meningomes did not differ significantly by sex. According to CBTRus data, the prevalence of non -malignant meningomes was 2.3 times higher in women than in men. 1 In this study, reports of incidence rates between women and men were highest in 35-54 year olds, where the IR of women was 3.29 times higher. 1 In this study, we identified the maximum ratio between 45 and 49 years. Perhaps sex-related factors play an important role, additional studies are necessary to explore the mechanism. 31

We also analyzed the IRs of the meningiomas according to the location of the tumor and found that 96.0 % of the patients had supratotory tumors, and that the infractient meningiomes were extremely rare, representing less than 0.1 %. In their study, Quinn et al pointed out that the majority of meningiomas (80.6 %) were in brain brain, 4.2 % in spinal and 14.5 % braids without indication of specific meningeal site. 1 In this study, we did not include patients whose tumor location was unknown, and the IRs of supratotory and spinal meningomes were quite similar between their study and ours.

In addition, we have studied the evolution of IRs of different types of meningiomas in different populations from 2004 to 2018. We observed an increase in the incidence of mild and atypical meningiomas from 2004 to 2018, but malignant meningioma showed a downward trend in the same period . In addition, we found that the APC increased until 2008 or 2009 with all the variables, including sex, age, race, ethnicity and location, then stabilized or even decreased until 2018. Meningiomas with brain invasion but without anaplasia were downgraded from WHO III to WHO II or I according to the updated guidelines published in 2000 and 2007, 13, 36, 37 which suggests that a certain trend can be due to changes in classification guidelines. It is interesting to note that we observed that the IR decreased for the first time in 2017-2018, and if this trend continues, it could support this hypothesis. However, other factors, including the aging of the population, the improvement of health services and diagnostic technologies, changes in the classification of tumors' codes declared by the register and the increase in the incidence of histological confirmation could possibly explain these trends.

Consequently, from a large database on meningiomas, we have updated the prevalence of the different types of meningiomas using two classification systems (CIM-O-3 and WHO). We then found that the majority of patients are elderly people, especially over 60s. Then, we found that the Méningiomes IR ratio for women compared to men increases with age and reached a 3.6 peak in the 45-49 year old group. We have also identified an increase in the frequency of mild and atypical meningiomas over time, but the APC increased until 2008 or 2009, then stabilized or even decreased until 2018.

4.2 Survival

Our study discovered a number of demographic and clinical characteristics associated with a worse survival rate in patients with meningiomas in the United States between 2004 and 2018. For all subtypes of meningiomas, advanced age was a major risk factor of worse prognosis. In addition, men and the black population had lower survival rates. Quinn et al. also noted that black patients had lower survival than whites among elderly patients 1 . Robert A. et al. studied mortality trends for black and white populations in the United States from 1900 to 2010. 38 They have advanced several explanations for the worst survival of the black population, including social and environmental factors, such as education, employment, poverty, hygiene; biological and behavioral factors, such as hypertension, cholesterol levels, smoking and diet; and preventive and therapeutic interventions and their access, such as vaccination, hypertension screening and the treatment of cardiovascular disease. Several of these factors can also contribute to the worst survival of black patients with meningiomas, such as late access to neuro-oncological care. However, molecular or epigenetic differences between breeds can also contribute to tumor behavior. Other studies are necessary to dissect the mechanisms underlying these differences.

We have also studied the effect of the location of the tumor on the SG. We have found that patients with supratottery meningioma had a higher risk of death than those with a spinal tumor, but this was only observed in patients with Benin meningioma and not in those with atypical or malignant tumors. Other research has shown that tumors located in cerebral convexity had a better prognosis than tumors located elsewhere (parasagittal, Falx, base of the skull). 39 This effect is probably due to the proximity of critical structures such as the upper sagittal sinus in the falx/parasagittal location, the cranial nerves, the cerebral trunk and the venous sinuses in the locations posterior/base of the skull. 40

Kaplan-Meier survival analysis said that patients with mild meningomes did not have significant differences in SG depending on the size of the tumor. However, patients with atypical and clever meningiomas have shown substantial differences in the SG, and patients with larger tumors (≥3 cm) had a higher risk of mortality than those with smaller tumors (<3 cm). In addition, the results of the multivariate proportional risk regression models of COX have shown that the size of the tumor significantly affected the survival of all types of patients with meningiomas, which was consistent with previous relationships, indicating that the size of the tumor is one of the most important prognostic factors affecting the recurrence of the tumor and the survival of patients. 40-44 Other studies are necessary to confirm the prognostic effect of the size of the tumor in these patients.

This study has shown that the treatment modality could affect SG substantially in patients with mild, atypical or malignant meningomes. We then analyzed the differences in the effect of the absence, of the STR and the GTR on the SG (additional figure 2). Our analysis has shown that for mild meningiomas, there were significant differences between two of the three surgical types, GTR patients surviving longer than STR, and STR surviving patients longer than NS patients. For atypical meningioma, we have observed a significant difference in survival between GTR and STR, but not between Str and NS. For malignant meningiomas, we have observed a significant difference in survival between Str and NS but not between GTR and Str. In addition, we have also compared the overall survival of surgery alone and surgery + RT, the results have shown that RTG + RT in malignant meningiomas lead to a significant increase in deaths compared to RTG alone, others without significant difference.

As patients with meningiomas generally have a good prognosis and long survival, it is necessary to analyze the data using a competing risk analysis to avoid the limits of the traditional analysis of overall survival, which includes the risk of death due to causes other than the tumor. For example, our previous analysis suggested that the overall survival of patients was linked to age and sex. However, it could also be an increase in age -related diseases as the patient ages, or a human -related disease, which leads to the death of the patient. We have overcome this bias by evaluating the parameters in the context of the death linked to the tumor, and the results imply that the influence of age or sex on survival is attributable to the specific characteristics of the tumor. Interestingly, we have also identified that the specific survival of the cause was affected by age, sex, size of the tumor and the processing method, which was identical to the analysis of overall survival. In addition, we have also compared survival specific to the cause of surgery alone and surgery + RT, the results have shown that the addition of RT in malignant meningiomas leads to a significant increase in deaths compared to the STR or the GTR alone (additional figure 1B). Similarly, several studies on meningiomas based on CBTRus or SEER have noted either a tendency to worse results in patients receiving adjuvant radiotherapy, or no difference in survival with adjuvant radiotherapy. 12, 40 There could be several reasons, such as the fact that the Seer database does not specify which type of radiotherapy is given, if it is adjuvant or rescue radiotherapy. Or, because it is a retrospective study, clinicians tend to select for radiotherapy patients with high -grade meningiomas, who have not been completely resulted or who are strongly recurrent. Consequently, it is necessary to conceive of a prospective multicenter study in the future, using the same radiotherapy modality and the same dose, in order to compare clearly if adjuvant radiotherapy can benefit patients with STR or GTR.

In meningiomas, many genetic and epigenetic anomalies have been discovered which are significantly linked to prognosis and which could be used as therapeutic targets. With the development of the overall analysis of methylation, the researchers have realized that epigenetic signatures or the classification of methylation -based meningomes have strong clinical associations with prognosis and are even more precise than the traditional classification of WHO 33, 45 SAHM and AL have analyzed the methylation profiles of 497 samples of meningomes and Distinguished six distinct methylation classes associated with typical mutational, cytogenetic and gene expression, which makes it possible to better predict the recurrence and the prognosis of the tumor than the classification of the WHO. 33 Olar et al have also gathered the meningiomas in two distinct subgroups by analysis of DNA methylation, which were correlated with the recurrence of the meningiomas. 34 Certain genes with abnormal methylation are also associated with tumorigesis, such as tumor protein 73 (TP73) and tissue inhibitor of metaloprotein 3 (TIMP3). 46 The methylation of the promoter of TP73 occurs in 7 % of meningiomas, mainly in atypical and anaplastic meningomes. 47 forty percent of anaplastic meningiomas have hypermethylation of TIMP3, which is correlated with a shorter recurrence time. 47 In addition, the methylation of PDCD1 and IGF2BP1 has been associated with increased clever potential and an aggressive phenotype. 48 The characterization of aggressive meningiomas at the molecular level can help stratify patients in distinct groups for recidivism and to orient treatment to more aggressive techniques for those with higher risk factors for recurrence. In the future, we hope that patient methylation profiles of patients can be included in the SEER database, which is important to predict patient results.

5 limits

This retrospective study based on the SEER database has several limits. First of all, the database is based on the American population, discoveries may not be able to be applied to the populations of other countries. In addition, there are certain limits linked to information not detailed from the database. For example, only brain meninges or spinal meninges have been recorded concerning the location of meningioma, there was no detailed location or adjacent fabric, such as if it invaded the venous sinus or not, whether it was the basis of the skull or not.

For surgical resection, Simpson classification, commonly used, has not been used. In addition, there are certain differences between the CIM-O-3 codes that we have used and the classification of the WHO usually used in the literature. Regarding adjuvant treatment, the mode or dose of radiotherapy is unclear, and information on the use of chemotherapy drugs in some patients is incomplete.

6 Conclusion

This study provides an in -depth examination of the incidence of meningomes and trends in patient survival depending on all demographic data. Despite several limitations, we were able to demonstrate that advanced age, male sex, black race and tumor size can be important prognostic factors. Our results also indicate that the resection of the tumor can considerably improve the survival of patients with meningioma. For future studies, it is necessary to conceive a multicenter prospective study, in order to clearly compare whether adjuvant radiotherapy can benefit patients with Str or GTR. In addition, in the future, we should not only carry out analyzes based on demographic and clinical factors, but also study molecular signatures, such as epigenetic alterations or genetic mutations in meningiomas.

Contributions from authors

Study design: JUNGUO CAO. Data collection: JUNGUO CAO, Weijia Yan, Guihong Li and Zhixin Zhan. Data analysis/interpretation: JUNGUO CAO and Weijia Yan. Preparation of figures: JUNGUO CAO, Hong Yan and Xinyu Hong. Writing of the manuscript: JUNGUO CAO. Revision/edition of the manuscript: JUNGUO CAO, Hong Yan and Xinyu Hong. All the work reported in this article was carried out by the authors, unless otherwise indicated in the text.

Financing information

This work was supported by the Xi'an Talent Program (Xayc200021) and a scholarship from the Chinese government (JUNGUO CAO, CSC: 201906170055; Weijia Yan, CSC: 202108080147).

Interest

The authors do not declare any conflict of potential interest.

Ethical declaration

The cases were collected in the SEER database and were analyzed anonymously; Therefore, no additional informed consent has been required.

  • 1 Ostrom QT , Patil N , Cioffi G , Waite K , Kruchko C , Barnholtz-Sloan JS . CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2013–2017 . Neuro-oncology . 2020 ; 22 : IV1 - IV96 .

Crossref Pubmed Web of Science® Google Scholar

  • 2 Weber RG , Boström J , Wolter M , et al. Analysis of Genomic Alterations in Benign, Atypical, and Anaplastic Meningiomas: Toward a Genetic Model of Meningioma Progression . Proc Natl Acad SCI USA . 1997 ; 94 : 14719 - 14724 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 3 ADEGBITE AB , Khan Mi , Paine KW , Tan LK . The reversal of intracranial meningiomas After Surgical Treatment . J neurosurg . 1983 ; 58 : 51 - 56 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 4 Menon G , Nair S , Sudhir J , Rao Br , Mathew A , Bahuleyan b . Childhood and adolescent meningiomas: a report of 38 boxes and review of literature . Acta Neurchir . 2009 ; 151 : 239 - 244 ; Discussion 44.

Crossref Case Pubmed Web of Science® Google Scholar

  • 5 li x , zhao j . Intracranial meningiomas of childhood and adolescence: Report of 34 boxes with follow-up . Childs nervous system . 2009 ; 25 : 1411 - 1417 .

Crossref Pubmed Web of Science® Google Scholar

  • 6 Zang KD . Meningioma: A Cytogenetic Model of A Complex Benign Human Tumor, Including Data on 394 Karyotyped Cases . Cytogenet Cell Genet . 2001 ; 93 : 207 - 220 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 7 Ketter R , Urbschat S , Henn W , et al. Application of oncogenetic trees mixtures as a biostatistical model of the clonal cytogenic evolution of meningiomas . Int j cancer . 2007 ; 121 : 1473 - 1480 .

Wiley Online Library Pubmed Web of Science® Google Scholar

  • 8 Ketter R , Rahnenführer J , Henn W , et al. Correspondence of Tumor Localization with tumor re -competitive and cytogenic progression in meningiomas . Neurosurgery . 2008 ; 62 : 61 - 69 ; Discussion 69-70.

Crossref Pubmed Web of Science® Google Scholar

  • 9 Ketter R , Henn W , Niedermayer I , et al. Predictive value of progression-associated chromosomal aberrations for the prognosis of meningiomas: a retrospective study of 198 boxes . J neurosurg . 2001 ; 95 : 601 - 607 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 10 Ostrom QT , McCulloh C , Chen Y , et al. Family History of Cancer in Benign Brain Tumor Subtypes versus Glimas . Front Oncol . 2012 ; 2 : 19 .

Crossref Pubmed Google Scholar

  • 11 Tufan K , Dogulu F , Kurt G , Emmez H , Ceviker N , Baykaner MK . Intracranial meningiomas of childhood and adolescence . Pediatr neurosurg . 2005 ; 41 : 1 - 7 .

Crossref Pubmed Web of Science® Google Scholar

  • 12 Achey RL , Gittleman H , Schroer J , Khanna V , Kruchko C , Barnholtz-Sloan JS . Nonmalignant and Malignant Meningioma Incidence and Survival in the Elderly, 2005-2015, Using the Central Brain Tumor Registry of the United States . Neuro Oncol . 2019 ; 21 : 380 - 391 .

Crossref Pubmed Web of Science® Google Scholar

  • 13 KSHETTRY VR , Ostrom QT , Kruchko C , Al-Mefty O , Barnett GH , Barnholtz-Sloan JS . Descriptive Epidemiology of World Health Organization Grades II and III intracranial meningiomas in the United States . Neuro Oncol . 2015 ; 17 : 1166 - 1173 .

Crossref Pubmed Web of Science® Google Scholar

  • 14 Chan RC , Thompson GB . Morbidity, Mortality, and Quality of Life Following Surgery for Intracranial Meningiomas. A Retrospective Study in 257 boxes . J neurosurg . 1984 ; 60 : 52 - 60 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 15 McCarthy BJ , Davis FG , Freels S , et al. Factors Associated with survival in patients with meningioma . J neurosurg . 1998 ; 88 : 831 - 839 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 16 Mahmood A , Caccamo DV , Tomecek FJ , Malik GM . Atypical and malignant meningiomas: a clinicopathological review . Neurosurgery . 1993 ; 33 : 955 - 963 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 17 Dobran M , Marini A , Nasi D , et al. Surgical Treatment and Outcome in Patients Over 80 Years Old with Intracranial Meningioma . Neurosurg clin . 2018 ; 167 : 173 - 176 .

Crossref Pubmed Web of Science® Google Scholar

  • 18 slot km , peters jvm , vartertop wp , verbaan d , peerdeman sm . Meningioma Surgery in Younger and Older Adults: Patient Profile and Surgical Outcomes . EUR GRIAT MED . 2018 ; 9 : 95 - 101 .

Crossref Pubmed Web of Science® Google Scholar

  • 19 Barthélemy E , Loewenstern J , Konuthula N , et al. Primary Management of Atypical Meningioma: Treatment Patterns and Survival Outcomes by Patient Age . J Cancer res clin oncol . 2018 ; 144 : 969 - 978 .

Crossref Pubmed Google Scholar

  • 20 Konglund A , Rogne SG , Lund-Johansen M , Scheie D , Helseth E , Meling Tr . OUTCOME FOLLOWING Surgery for intracranial meningiomas in the aging . Acta Neurol Scand . 2013 ; 127 : 161 - 169 .

Wiley Online Library Pubmed Web of Science® Google Scholar

  • 21 Steinberger J , Bronheim RS , Vepati P , et al. Morbidity and Mortality of Meningioma Increases in octagenarians . World Neurosurg . 2018 ; 109 : E16 - E23 .

Crossref Pubmed Web of Science® Google Scholar

  • 22 Connolly ID , Cole T , Veeravagu A , Popat R , Ratliff J , Li g . Craniotomy for Resection of Meningioma: An Age-Stratified Analysis of the MarketScan Longitudinal Database . World Neurosurg . 2015 ; 84 : 1864 - 1870 .

Crossref Pubmed Web of Science® Google Scholar

  • 23 Petrakakis I , Pirayesh A , Krauss JK , Raab P , Hartmann C , Nakamura m . The Sellar and Suprasellar Region: a “hideaway” of rare lesions. Clinical aspects, Imaging Findings, Surgical Outcome and Comparative Analysis . Neurosurg clin . 2016 ; 149 : 154 - 165 .

Crossref Pubmed Web of Science® Google Scholar

  • 24 COHEN-INBAR O , SOUSTAL JF , Zaaroor m . Meningiomas in the Elderly, The Surgical Benefit and A New Scoring System . Acta Neurchir . 2010 ; 152 : 87 - 97 ; Discussion 97.

Crossref Pubmed Web of Science® Google Scholar

  • 25 Boviatsis ej , bouras ti , kouyialis at , Themistocleous ms , sakas de . Impact of Age on Complications and Outcome in Meningioma Surgery . Surg neurol . 2007 ; 68 : 407 - 411 ; Discussion 11.

Crossref Pubmed Web of Science® Google Scholar

  • 26 POON MT , FUNG LH , PU JK , Leung GK . OUTCOME Comparison Between Younger and Older Patients Undergo Intracranial Meningioma Resections . J Neurooncol . 2013 ; 114 : 219 - 227 .

Crossref Pubmed Web of Science® Google Scholar

  • 27 Brokinkel B , Holling M , Spille DC , et al. Surgery for Meningioma in the Elderly and Long-Term Survival: Comparison With An Age- and Sex-Matched General Population and With Younger . J neurosurg . 2017 ; 126 : 1201 - 1211 .

Crossref Pubmed Web of Science® Google Scholar

  • 28 Hasseleid BF , MELING TR , Rønning P , Scheie D , Helseth E. Surgery for convexity meningioma: Simpson grade i resection as the goal: clinical article . J neurosurg . 2012 ; 117 : 999 - 1006 .

Crossref Pubmed Web of Science® Google Scholar

  • 29 Stafford SL , Perry A , Suman VJ , et al. Primary reseted meningiomas: Outcome and Prognostic Factors in 581 Mayo Clinic Patients, 1978 through 1988 . Mayo Clin Proc . 1998 ; 73 : 936 - 942 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 30 Seer Program . Surveillance, Epidemiology, and End Results (SEER) ; 2021 . https://seer.cancer.gov . Accesed December 10, 2021.

Google Scholar

  • 31 Wiemels J , Wrensch M , Claus EB . Epidemiology and Etiology of Meningioma . J Neurooncol . 2010 ; 99 : 307 - 314 .

Crossref Pubmed Web of Science® Google Scholar

  • 32 Shaikh n , dixit K , Raizer j . Recent Advances in Managing/Understanding Meningioma . F1000RESEARCH . 2018 ; 7 : 490. DOI: 10.12688/f1000research. 113674.1

Crossref Google Scholar

  • 33 SAHM F , SCHRIMPF D , Stichel D , et al. DNA Methylation-Based Classification and Grading System for Meningioma: A Multicenter, Retrospective Analysis . Lancet Oncol . 2017 ; 18 : 682 - 694 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 34 Olar A , Wani Km , Wilson CD , et al. Global Epigenetic Profiles Identifies Methylation Subgroups Associated With Recurrence-Free Survival in Meningioma . Acta Neuropathol . 2017 ; 133 : 431 - 444 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 35 Majchrzak-Coulińska A , Paluszczak J , Szalata M , Barciszewska Am , Nowak S , Baer-Dubowska w . DNA Methylation Analysis of Benign and Atypical Meningiomas: Correlation Between Runx3 Methylation and who Grade . J Cancer res clin oncol . 2015 ; 141 : 1593 - 1601 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 36 MONNYák B , Bognár L , Klekner Á , Hortobágyi t . Epigenetics of meningiomas . Biomed res . 2015 ; 2015 : 532451.

Crossref Case Pubmed Web of Science® Google Scholar

  • 37 Commins DL , Atkinson RD , Burnett Me . Review of Meningioma Histopathology . Neurosurg focus . 2007 ; 23 : E3 .

Crossref Pubmed Google Scholar

  • 38 HAHN RA . Survival in adversity: Trends in Mortality Among Blacks in the United States, 1900-2010 . Int j Health Serv . 2020 ; 50 : 387 - 395 .

Crossref Pubmed Web of Science® Google Scholar

  • 39 Palma L , Celli P , Franco C , Cervoni L , Cantore g . Long-Term Prognosis for Atypical and Malignant Meningiomas: A Study of 71 Surgical Cases . J neurosurg . 1997 ; 86 : 793 - 800 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 40 Garzon-Muvdi T , Yang W , Lim M , Brem H , Huang J. Atypical and anaplastic meningioma: outcomes in a population based study . J Neurooncol . 2017 ; 133 : 321 - 330 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 41 Domingues pH , sousa p , otero Á , et al. SOPALL FOR A NEW RISK STRATIFICAL CLASSIFICATION FOR MENINGIOMA BASED ON PAINT AGE, WHO TUMOR GRADE, SIZE, LOCALIZATION, AND KARYOTYPE . Neuro Oncol . 2014 ; 16 : 735 - 747 .

Crossref Pubmed Web of Science® Google Scholar

  • 42 Yang Sy , Park CK , Park SH , Kim DG , Chung Ys , Jung Hw . Atypical and anaplastic meningiomas: Prognostic Implications of Clinicopathological Features . J neurol neurosurg psychiatry . 2008 ; 79 : 574 - 580 .

Crossref Pubmed Web of Science® Google Scholar

  • 43 GOYAL LK , SUH JH , Mohan DS , PRAYSON RA , Lee J , Barnett GH . Local Control and Overall Survival in Atypical Meningioma: A Retrospective Study . Int J Radiat Oncol Biol Phys . 2000 ; 46 : 57 - 61 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 44 Durand A , Labrousse F , Jouvet A , et al. Who Grade II and III Meningiomas: A Study of Prognostic Factors . J Neurooncol . 2009 ; 95 : 367 - 375 .

Crossref Pubmed Web of Science® Google Scholar

  • 45 Sandoval J , esteller m . Cancer Epigenomics: Beyond Genomics . CURR OPI GENET DEV . 2012 ; 22 : 50 - 55 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 46 Bello MJ , Amiñoso C , Lopez-Marin I , et al. DNA Methylation of multiple promoter-associated cpg islands in meningiomas: relationship with the alic status at 1p and 22q . Acta Neuropathol . 2004 ; 108 : 413 - 421 .

Crossref Case Pubmed Web of Science® Google Scholar

  • 47 Barski D , Wolter M , Reifenberger G , Riemenschneider MJ . Hypermethylation and Transcriptional Downregulation of the Timp3 gene is Associated With Alic Loss On 22q12.3 and Malignancy in Meningiomas . Brain Pathol (Zurich, Switzerland) . 2010 ; 20 : 623 - 631 .

Wiley Online Library Pubmed Web of Science® Google Scholar

  • 48 Vingoechea J , Sloan AE , Chen Y , et al. Methylation Markers of Malignant Potential in Meningiomas . J neurosurg . 2013 ; 119 : 899 - 906 .

Crossref Case Pubmed Web of Science® Google Scholar

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