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. 2024 Feb 5;6(1):vdae018.
doi: 10.1093/noajnl/vdae018. eCollection 2024 Jan-Dec.

Analysis of demographics and the impact of adjuvant radiotherapy on a nationwide cohort of patients with high-grade spinal meningiomas

Victor Gabriel El-Hajj  1   2   3 , Abdul Karim Ghaith  2   3 , Ryan H Nguyen  2   3 , Neil Nazar Al-Saidi  2   3 , Harry Hoang  2 , Stephen P Graepel  2   3 , Adrian Elmi-Terander  1   4 , Eric J Lehrer  5 , Paul Brown  5 , Mohamad Bydon  2   3
Affiliations

Analysis of demographics and the impact of adjuvant radiotherapy on a nationwide cohort of patients with high-grade spinal meningiomas

Victor Gabriel El-Hajj et al. Neurooncol Adv. .

Abstract

Background: Although typically benign, 5% of spinal meningiomas (SMs) present with higher-grade features (World Health Organization grades 2 and 3). High-grade SMs are poorly studied and the role of adjuvant radiotherapy in their management remains controversial. We hence aimed to study the demographic characteristics of this rare tumor and investigate the outcomes associated with the use of surgery with adjuvant therapy in contrast to surgery alone.

Methods: The National Cancer Database was queried for patients with SMs from 2004 to 2017. Basic statistics were used to identify differences between low- and high-grade tumors in terms of baseline characteristics. Surgery with and without adjuvant radiotherapy were compared after (1:1) propensity-score matching. Kaplan-Meier survival analysis was conducted to study overall survival. All analyses were performed on R.

Results: A total of 13 184 patients diagnosed with SMs were included, of whom only 5% (n = 669) had high-grade SMs. Patients with high-grade SMs presented at a younger median age (57 years [IQR: 44-68] versus 65 years [54-75]; P < .001) and were more commonly males (33% vs 20%; P < .001). After propensity-score matching, survival analysis revealed similar overall survival outcomes in patients with high-grade SM undergoing both surgery and radiotherapy as compared to those only receiving surgery (P = .19).

Conclusions: This study reveals major demographic differences between high- and low-grade SMs. There were no benefits associated with the use of adjuvant radiotherapy. However, due to confounding, overall survival outcomes between patients receiving surgery alone and those receiving surgery with adjuvant radiotherapy are not causally interpretable.

Keywords: adjuvant radiotherapy; high grade; overall survival; spinal meningiomas; surgery.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Illustrations showing the skin incision markings (A), the intradural operative view of a ventral spinal meningioma (B), the anatomical location of the tumor in relation to the spinal elements (C), and the patient receiving adjuvant radiotherapy (D).
Figure 2.
Figure 2.
Inclusion flowchart.
Figure 3.
Figure 3.
Kaplan–Meier survival curves showing overall survival over time (months), for the high-grade SM cohort prior to matching (A), stratified by treatment type and prior to matching (B), and stratified by treatment and after propensity score matching (C).
See this image and copyright information in PMC

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References

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