“Wait-and-See” Strategies for Newly Diagnosed Intracranial Meningiomas Based on the Risk of Future Observation Failure

Eun Jung Lee, Jin Hoon Park, Eun Suk Park, Jeong Hoon Kim

Research output: Contribution to journalArticleResearchpeer-review

4 Citations (Scopus)

Abstract

Objective To analyze factors affecting observation failure (Ob-F) of untreated intracranial meningiomas (IMs) and to develop a “wait-and-see” strategy for newly diagnosed IMs based on risk. Methods Factors affecting Ob-F (i.e., development of neurologic symptoms, significant growth, loss of opportunity to do radiosurgery, and tumor invasion into the adjacent sinus) were examined using a multivariate Cox proportional hazard model. The utility of the Asan Intracranial Meningiomas Scoring System (AIMSS) for screening out patients at risk for Ob-F was also analyzed. The “wait-and-see” strategy was based on the growth rate affecting the 5-year observation success (Ob-S) rate. Results Over 46.9 months, 77 of 232 patients (33.2%) experienced Ob-F. Larger tumors, preexisting neurologic symptoms, absence of calcification, and isointense/hyperintense signal were predictors of Ob-F. An AIMSS score of 4 for tumors <2.5 cm in diameter (P = 0.0002) and a score of 6 for tumors ≥2.5 to <4.0 cm in diameter screened out tumors at risk for Ob-F (P = 0.0023). Initial growth rates of ≥20%/year for tumors <2.5 cm (P < 0.0001) and ≥1 cm 3 /year for tumors ≥2.5 to <4.0 cm (P = 0.0019) were predictive of 5-year Ob-S rate; however, tumors ≥4 cm tended to experience Ob-F, regardless of score group or growth rate. Conclusions The AIMSS is helpful for screening out IMs at risk for Ob-F at the time of diagnosis. The initial growth rate after follow-up predicts the risk of future Ob-F in small- to medium- sized IMs.

Original languageEnglish
Pages (from-to)604-611
Number of pages8
JournalWorld Neurosurgery
Volume107
DOIs
StatePublished - 1 Nov 2017
Externally publishedYes

Fingerprint

Meningioma
Observation
Neoplasms
Growth
Neurologic Manifestations
Nervous System Neoplasms
Radiosurgery
Proportional Hazards Models
Statistical Factor Analysis

Keywords

  • Meningioma
  • Natural history
  • Prognosis
  • Risk assessment

Cite this

@article{b7dc6c97534244bbb815ff861704e0ef,
title = "“Wait-and-See” Strategies for Newly Diagnosed Intracranial Meningiomas Based on the Risk of Future Observation Failure",
abstract = "Objective To analyze factors affecting observation failure (Ob-F) of untreated intracranial meningiomas (IMs) and to develop a “wait-and-see” strategy for newly diagnosed IMs based on risk. Methods Factors affecting Ob-F (i.e., development of neurologic symptoms, significant growth, loss of opportunity to do radiosurgery, and tumor invasion into the adjacent sinus) were examined using a multivariate Cox proportional hazard model. The utility of the Asan Intracranial Meningiomas Scoring System (AIMSS) for screening out patients at risk for Ob-F was also analyzed. The “wait-and-see” strategy was based on the growth rate affecting the 5-year observation success (Ob-S) rate. Results Over 46.9 months, 77 of 232 patients (33.2{\%}) experienced Ob-F. Larger tumors, preexisting neurologic symptoms, absence of calcification, and isointense/hyperintense signal were predictors of Ob-F. An AIMSS score of 4 for tumors <2.5 cm in diameter (P = 0.0002) and a score of 6 for tumors ≥2.5 to <4.0 cm in diameter screened out tumors at risk for Ob-F (P = 0.0023). Initial growth rates of ≥20{\%}/year for tumors <2.5 cm (P < 0.0001) and ≥1 cm 3 /year for tumors ≥2.5 to <4.0 cm (P = 0.0019) were predictive of 5-year Ob-S rate; however, tumors ≥4 cm tended to experience Ob-F, regardless of score group or growth rate. Conclusions The AIMSS is helpful for screening out IMs at risk for Ob-F at the time of diagnosis. The initial growth rate after follow-up predicts the risk of future Ob-F in small- to medium- sized IMs.",
keywords = "Meningioma, Natural history, Prognosis, Risk assessment",
author = "Lee, {Eun Jung} and Park, {Jin Hoon} and Park, {Eun Suk} and Kim, {Jeong Hoon}",
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language = "English",
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journal = "World Neurosurgery",
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}

“Wait-and-See” Strategies for Newly Diagnosed Intracranial Meningiomas Based on the Risk of Future Observation Failure. / Lee, Eun Jung; Park, Jin Hoon; Park, Eun Suk; Kim, Jeong Hoon.

In: World Neurosurgery, Vol. 107, 01.11.2017, p. 604-611.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - “Wait-and-See” Strategies for Newly Diagnosed Intracranial Meningiomas Based on the Risk of Future Observation Failure

AU - Lee, Eun Jung

AU - Park, Jin Hoon

AU - Park, Eun Suk

AU - Kim, Jeong Hoon

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objective To analyze factors affecting observation failure (Ob-F) of untreated intracranial meningiomas (IMs) and to develop a “wait-and-see” strategy for newly diagnosed IMs based on risk. Methods Factors affecting Ob-F (i.e., development of neurologic symptoms, significant growth, loss of opportunity to do radiosurgery, and tumor invasion into the adjacent sinus) were examined using a multivariate Cox proportional hazard model. The utility of the Asan Intracranial Meningiomas Scoring System (AIMSS) for screening out patients at risk for Ob-F was also analyzed. The “wait-and-see” strategy was based on the growth rate affecting the 5-year observation success (Ob-S) rate. Results Over 46.9 months, 77 of 232 patients (33.2%) experienced Ob-F. Larger tumors, preexisting neurologic symptoms, absence of calcification, and isointense/hyperintense signal were predictors of Ob-F. An AIMSS score of 4 for tumors <2.5 cm in diameter (P = 0.0002) and a score of 6 for tumors ≥2.5 to <4.0 cm in diameter screened out tumors at risk for Ob-F (P = 0.0023). Initial growth rates of ≥20%/year for tumors <2.5 cm (P < 0.0001) and ≥1 cm 3 /year for tumors ≥2.5 to <4.0 cm (P = 0.0019) were predictive of 5-year Ob-S rate; however, tumors ≥4 cm tended to experience Ob-F, regardless of score group or growth rate. Conclusions The AIMSS is helpful for screening out IMs at risk for Ob-F at the time of diagnosis. The initial growth rate after follow-up predicts the risk of future Ob-F in small- to medium- sized IMs.

AB - Objective To analyze factors affecting observation failure (Ob-F) of untreated intracranial meningiomas (IMs) and to develop a “wait-and-see” strategy for newly diagnosed IMs based on risk. Methods Factors affecting Ob-F (i.e., development of neurologic symptoms, significant growth, loss of opportunity to do radiosurgery, and tumor invasion into the adjacent sinus) were examined using a multivariate Cox proportional hazard model. The utility of the Asan Intracranial Meningiomas Scoring System (AIMSS) for screening out patients at risk for Ob-F was also analyzed. The “wait-and-see” strategy was based on the growth rate affecting the 5-year observation success (Ob-S) rate. Results Over 46.9 months, 77 of 232 patients (33.2%) experienced Ob-F. Larger tumors, preexisting neurologic symptoms, absence of calcification, and isointense/hyperintense signal were predictors of Ob-F. An AIMSS score of 4 for tumors <2.5 cm in diameter (P = 0.0002) and a score of 6 for tumors ≥2.5 to <4.0 cm in diameter screened out tumors at risk for Ob-F (P = 0.0023). Initial growth rates of ≥20%/year for tumors <2.5 cm (P < 0.0001) and ≥1 cm 3 /year for tumors ≥2.5 to <4.0 cm (P = 0.0019) were predictive of 5-year Ob-S rate; however, tumors ≥4 cm tended to experience Ob-F, regardless of score group or growth rate. Conclusions The AIMSS is helpful for screening out IMs at risk for Ob-F at the time of diagnosis. The initial growth rate after follow-up predicts the risk of future Ob-F in small- to medium- sized IMs.

KW - Meningioma

KW - Natural history

KW - Prognosis

KW - Risk assessment

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U2 - 10.1016/j.wneu.2017.08.060

DO - 10.1016/j.wneu.2017.08.060

M3 - Article

VL - 107

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EP - 611

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

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