A prognostic model to personalize monitoring regimes for patients with incidental asymptomatic meningiomas.



Islim, Abdurrahman I ORCID: 0000-0001-9621-043X, Kolamunnage-Dona, Ruwanthi ORCID: 0000-0003-3886-6208, Mohan, Midhun, Moon, Richard DC, Crofton, Anna, Haylock, Brian J, Rathi, Nitika, Brodbelt, Andrew R, Mills, Samantha J and Jenkinson, Michael D ORCID: 0000-0003-4587-2139
(2019) A prognostic model to personalize monitoring regimes for patients with incidental asymptomatic meningiomas. Neuro-oncology.

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Abstract

BACKGROUND:Asymptomatic meningioma is a common incidental finding with no consensus on the optimal management strategy. We aimed to develop a prognostic model to guide personalized monitoring of incidental meningioma patients. METHODS:A prognostic model of disease progression was developed in a retrospective cohort (2007-2015), defined as: symptom development, meningioma-specific mortality, meningioma growth or loss of window of curability. Secondary endpoints included non-meningioma-specific mortality and intervention. RESULTS:Included were 441 patients (459 meningiomas). Over a median of 55 months (interquartile range, 37-80), 44 patients had meningioma progression and 57 died (non-meningioma-specific). Forty-four had intervention (at presentation, n = 6; progression, n = 20; nonprogression, n = 18). Model parameters were based on statistical and clinical considerations and included: increasing meningioma volume (hazard ratio [HR] 2.17; 95% CI: 1.53-3.09), meningioma hyperintensity (HR 10.6; 95% CI: 5.39-21.0), peritumoral signal change (HR 1.58; 95% CI: 0.65-3.85), and proximity to critical neurovascular structures (HR 1.38; 95% CI: 0.74-2.56). Patients were stratified based on these imaging parameters into low-, medium- and high-risk groups and 5-year disease progression rates were 3%, 28%, and 75%, respectively. After 5 years of follow-up, the risk of disease progression plateaued in all groups. Patients with an age-adjusted Charlson comorbidity index ≥6 (eg, an 80-year-old with chronic kidney disease) were 15 times more likely to die of other causes than to receive intervention at 5 years following diagnosis, regardless of risk group. CONCLUSIONS:The model shows that there is little benefit to rigorous monitoring in low-risk and older patients with comorbidities. Risk-stratified follow-up has the potential to reduce patient anxiety and associated health care costs.

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 14 Oct 2019 07:22
Last Modified: 28 Nov 2019 09:16
DOI: 10.1093/neuonc/noz160
Open Access URL: https://academic.oup.com/neuro-oncology/advance-ar...
URI: http://livrepository.liverpool.ac.uk/id/eprint/3057991
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