Abstract：
BACKGROUND: Survival after meningioma surgery is often reported with inadequate allowance for competing causes of death.
METHODS: We processed the French administrative medical database (Système National des Données de Santé: SNDS), to retrieve appropriate cases of surgically treated meningioma. Cause-specific survival in meningioma-related death was analyzed with the Fine & Gray (F&G) and cause-specific (CS) Cox models to identify associated factors.
RESULTS: Five-year cumulative incidence was 2.85% for meningioma-related death and 6.3% for unrelated death (P<0.001). In the adjusted F&G and cause-specific Cox regression models for meningioma-related death, gender, age at surgery, co-morbidities, neurofibromatosis type 2, tumor insertion, tumor grade, cerebrospinal fluid (CSF) shunt insertion, preoperative embolization and need for redo surgery for recurrence emerged as independent prognostic factors of cause-specific survival (CSS) in meningioma-related death.
CONCLUSIONS: At 5 years, the risk of meningioma-unrelated death was 2.21-fold greater than the risk of dying from the meningioma disease. Five-year CSS after meningioma surgery was greater in younger adults with benign spinal meningioma with low comorbidity. Those with malignant cranial tumor requiring preoperative embolization or CSF shunting for associated hydrocephalus and with severely degraded overall health status showed a significantly increased risk of meningioma-related death. Redo surgery for recurrence failed to improve the risk of meningioma-related death. We recommend the use of net survival methods such as CSS in meningioma studies where unrelated mortality is predominant, as this approach results in more accurate estimates of disease risk and associated predictors.
METHODS: We processed the French administrative medical database (Système National des Données de Santé: SNDS), to retrieve appropriate cases of surgically treated meningioma. Cause-specific survival in meningioma-related death was analyzed with the Fine & Gray (F&G) and cause-specific (CS) Cox models to identify associated factors.
RESULTS: Five-year cumulative incidence was 2.85% for meningioma-related death and 6.3% for unrelated death (P<0.001). In the adjusted F&G and cause-specific Cox regression models for meningioma-related death, gender, age at surgery, co-morbidities, neurofibromatosis type 2, tumor insertion, tumor grade, cerebrospinal fluid (CSF) shunt insertion, preoperative embolization and need for redo surgery for recurrence emerged as independent prognostic factors of cause-specific survival (CSS) in meningioma-related death.
CONCLUSIONS: At 5 years, the risk of meningioma-unrelated death was 2.21-fold greater than the risk of dying from the meningioma disease. Five-year CSS after meningioma surgery was greater in younger adults with benign spinal meningioma with low comorbidity. Those with malignant cranial tumor requiring preoperative embolization or CSF shunting for associated hydrocephalus and with severely degraded overall health status showed a significantly increased risk of meningioma-related death. Redo surgery for recurrence failed to improve the risk of meningioma-related death. We recommend the use of net survival methods such as CSS in meningioma studies where unrelated mortality is predominant, as this approach results in more accurate estimates of disease risk and associated predictors.
摘要：
背景：经常报道脑膜瘤手术后的生存率，但对竞争性死亡原因的考虑不足。
方法：我们处理了法国行政医疗数据库（SystèmeNationaldesDonnéesdeSanté：SNDS），检索手术治疗脑膜瘤的适当病例。使用Fine＆Gray（F＆G）和原因特异性（CS）Cox模型分析脑膜瘤相关死亡的原因特异性生存率，以确定相关因素。
结果：脑膜瘤相关死亡的五年累积发生率为2.85%，非相关死亡的五年累积发生率为6.3%（P<0.001）。在脑膜瘤相关死亡的校正F&G和原因特异性Cox回归模型中，性别,手术年龄，合并症,神经纤维瘤病2型，肿瘤插入，肿瘤分级,脑脊液（CSF）分流插入，在脑膜瘤相关死亡中,术前栓塞和复发需要重做手术是病因特异性生存(CSS)的独立预后因素.
结论：在5岁时，与脑膜瘤无关的死亡风险是死于脑膜瘤疾病的风险的2.21倍.脑膜瘤手术后的五年CSS在患有良性脊髓脑膜瘤且合并症低的年轻人中更高。患有恶性颅骨肿瘤的患者需要术前栓塞或脑脊液分流以进行相关的脑积水，并且总体健康状况严重下降，其脑膜瘤相关死亡的风险显着增加。复发的重做手术未能改善脑膜瘤相关死亡的风险。我们建议在脑膜瘤研究中使用净生存方法，如CSS，其中无关死亡率占主导地位，因为这种方法可以更准确地估计疾病风险和相关预测因子。
方法：我们处理了法国行政医疗数据库（SystèmeNationaldesDonnéesdeSanté：SNDS），检索手术治疗脑膜瘤的适当病例。使用Fine＆Gray（F＆G）和原因特异性（CS）Cox模型分析脑膜瘤相关死亡的原因特异性生存率，以确定相关因素。
结果：脑膜瘤相关死亡的五年累积发生率为2.85%，非相关死亡的五年累积发生率为6.3%（P<0.001）。在脑膜瘤相关死亡的校正F&G和原因特异性Cox回归模型中，性别,手术年龄，合并症,神经纤维瘤病2型，肿瘤插入，肿瘤分级,脑脊液（CSF）分流插入，在脑膜瘤相关死亡中,术前栓塞和复发需要重做手术是病因特异性生存(CSS)的独立预后因素.
结论：在5岁时，与脑膜瘤无关的死亡风险是死于脑膜瘤疾病的风险的2.21倍.脑膜瘤手术后的五年CSS在患有良性脊髓脑膜瘤且合并症低的年轻人中更高。患有恶性颅骨肿瘤的患者需要术前栓塞或脑脊液分流以进行相关的脑积水，并且总体健康状况严重下降，其脑膜瘤相关死亡的风险显着增加。复发的重做手术未能改善脑膜瘤相关死亡的风险。我们建议在脑膜瘤研究中使用净生存方法，如CSS，其中无关死亡率占主导地位，因为这种方法可以更准确地估计疾病风险和相关预测因子。
