Purpose: Older patients have inferior outcomes for meningioma and experience more post-operative complications. The purpose of this study was to identify national treatment patterns and outcomes based on age for benign meningiomas using the National Cancer Database (NCDB).
Material and methods: The NCDB was queried for patients with biopsy-proven World Health Organization Grade (WHO) grade I meningioma diagnosed between 2004 and 2015. Patients were stratified based on age: 18-50, 51-60, 61-70, 71-80, and > 80 years of age. Clinicodemographic details were compared via the Chi Square test. Multivariable logistic regression was used to determine factors associated with receipt of treatment and post-operative complications. Multivariable Cox regression and the Kaplan-Meier method were used to examine survival.
Results: 56,960 patients met inclusion criteria with a median follow-up of 48 months. Ages 61-70 (OR 0.73, 95% CI 0.62-0.85, p < .001), ages 71-80 (OR 0.51, 95% CI 0.43-0.60, p < .001), and age > 80 (0.16, 95% CI 0.14-0.19, p < .001) were less likely to receive treatment. Older age groups were associated with increased risk of post-operative complications and post-operative complications predicted for decreased survival. Treatment with surgery (HR 0.57, 95% CI 0.52-0.62, p < .001) and surgery and radiation (HR 0.59, 95% CI 0.50-0.70, p < .001) provided a survival benefit. Older age was associated with a survival decrement.
Conclusions: Older patients are less likely to undergo treatment for benign meningioma and are more likely to have post-operative complications. Survival decreased with increasing age. Treatment improved survival among all patients. Risk-benefit ratio of treatment should be carefully considered when treating older patients with benign meningioma.
Keywords: Benign meningioma; Older patients; Radiation; Surgery.
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