背景:仍然缺乏对恶性脑膜瘤(MM)患者的预后因素和治疗策略的综合研究,并调整竞争性死亡原因。
方法:监测,流行病学,和最终结果(SEER)数据库用于包括2004年至2018年患有这种罕见疾病的成年患者。MM引起的死亡率(MMCM)和非MM引起的死亡率(非MMCM)的概率由累积发生率函数曲线表示。然后,通过cox比例风险模型评估变量与非MMCM之间的关联,通过Fine-Gray竞争风险回归模型确定MMCM的预后因素。此外,开发了一个列线图来预测1年,2年,和5年MMCM,并通过接收器工作特性(ROC)曲线下的时间依赖性区域和校准来测试性能。
结果:纳入577例患者,中位年龄为62岁(18-100岁),中位总生存时间为36个月(0-176个月)。在整个人群中,非MMCM的百分比为15.4%(n=89),在老年患者中为21.7%(n=54)。多变量Cox比例风险回归模型显示,MM之前或之后的年龄和其他肿瘤与较高的非MMCM具有独立的显着关联。在调整了竞争性死亡原因后,多变量精细-灰色回归模型确定的年龄组≥65岁,肿瘤大小>5.3厘米,复发性MM,和组织学类型9530/3(脑膜瘤,恶性)与较高的MMCM具有独立的显着关联。与肿瘤总有效率(GTR)相比,肿瘤次全切除(HR1.66,95CI1.08-2.56,P=0.02),肺叶部分切除(HR2.26,95CI1.32-3.87,P=0.003),肺叶的总切除(HR1.69,95CI1.12-2.51,P=0.01)与较高的MMCM具有独立的显着相关性。
结论:竞争风险列线图包括年龄组,肿瘤大小,初始状态,组织学类型,和程度的切除是有区别的和临床上有用的。这项研究强调了肿瘤GTR在MM患者治疗中的重要性。与活检相比,MMCM的发生率明显较低,肿瘤的STR,肺叶部分切除,和波瓣的GTR。
BACKGROUND: Comprehensive investigations of the prognosis factors and treatment strategies with adjustment of competing causes of death for patients with malignant meningioma (MM) is still lacking.
METHODS: The surveillance, Epidemiology, and End Results (SEER) database were used to include adult patients with this rare disease between 2004 and 2018. The probability of MM-caused mortality (MMCM) and non-MM-caused mortality (non-MMCM) were presented by cumulative incidence function curves. Then, the association between variates with non-MMCM was evaluated by the cox proportional hazard model, and the prognostic factors of MMCM were identified by Fine-Gray competing risk regression model. Furthermore, a nomogram was developed to predict the 1-year, 2-year, and 5-year MMCM and the performance was tested by a time-dependent area under the receiver operating characteristic (ROC) curve and calibration.
RESULTS: 577 patients were included, with a median age of 62 (18-100) years old and a median overall survival time of 36 (0-176) months. The percentage of non-MMCM was 15.4% (n = 89) in the entire population and 21.7% (n = 54) in elderly patients. The multivariable Cox proportional hazard regression model revealed that older age and other tumor(s) before or after MM had an independently significant association with higher non-MMCM. After adjustment of competing causes of death, the multivariable Fine-gray regression model identified age group ≥ 65 year, tumor size > 5.3 cm, recurrent MM, and histologic type 9530/3 (Meningioma, malignant) had an independently significant association with higher MMCM. Compared with gross total (GTR) of tumor, subtotal resection of tumor (HR 1.66, 95%CI 1.08-2.56, P = 0.02), partial resection of lobe (HR 2.26, 95%CI 1.32-3.87, P = 0.003), and gross total resection of lobe (HR 1.69, 95%CI 1.12-2.51, P = 0.01) had an independently significant association with higher MMCM.
CONCLUSIONS: The competing risk nomogram including age group, tumor size, initial status, histologic type, and extent of resection is discriminative and clinically useful. This study emphasized the importance of the GTR of tumor in the treatment of MM patients, which had a significantly lower incidence of MMCM compared with biopsy, STR of tumor, partial resection of lobe, and GTR of lobe.