Related Experiment Video
Updated: Aug 16, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Relative survival after meningioma surgery. A French nationwide population-based cohort study
Charles Champeaux-Depond1,2, Panayotis Constantinou3, Philippe Tuppin3
1Department of Neurosurgery, Lariboisière Hospital, Paris, France.
Background:
Survival after meningioma surgery is often reported with inadequate allowance for competing causes of death.
Methods:
We processed the Système National des Données de Santé, the French administrative medical database to retrieve appropriate patients' case of surgically treated meningiomas. The Pohar Perme relative survival (RS) method was implement.
Results:
A total of 28,778 patients were identified between 2007 and 2017 of which 75% were female. Median age at surgery 59 years. Cranial convexity was the most common (24.7%) location and, benign meningioma represented 91.5% of all meningioma. Median follow-up was 3.5 years interquartile range [3.4-3.5]. At data collection, 2,232 patients were dead. The five-year survival relative to the expected survival of an age- and gender-matched French standard population was 96.2% 95% confidence interval (CI)[95.7-96.8]. Meningioma absolute excess risk of death was 973/100,000 person-years 95%CI[887-1068] (p< .001). The related standardised mortality ratio was 1.8 95%CI[1.7-1.9] (p< .001). In the adjusted model, male gender (hazard ratio [HR] =1.39, 95%CI[1.27-1.54], p< .001), age at surgery (HR=0.97, 95%CI[0.97-0.97], p < .001), type 2 neurofibromatosis (HR=2.95, 95%CI[1.95-4.46], p < .001), comorbidities HR=1.39, 95%CI[1.36-1.42], p < .001), location (HR=0.8, 95%CI[0.67-0.95], p= .0111), pre-operative embolization, (HR=1.3, 95%CI[1.08-1.56], p= .00507), cerebro-spinal fluid shunt, (HR=2.48, 95%CI[2.04-3.01], p < .001), atypical (HR=1.3, 95%CI [1.09-1.54], p= .00307) or malignant histology (HR=1.86, 95%CI[1.56-2.22], p< .001), redo surgery (HR=1.19, 95%CI[1.04-1.36], p= .0122) and radiotherapy (HR=1.43, 95%CI[1.26-1.62], p < .001) were established as independent predictors of RS.
Conclusion:
This unique study highlights the excess mortality associated with meningioma disease. Many factors such as gender, age, location, histopathological grading, redo surgery influence the RS.
Insights
Meningioma surgery survival rates are higher than previously thought, but excess mortality risks persist. Factors like male gender, age, tumor location, and treatment influence survival outcomes for meningioma patients.
Area of Science:
- Neurosurgery
- Oncology
- Epidemiology
- Public Health
Background:
- Survival rates after meningioma surgery are often overestimated due to not accounting for competing causes of death.
- Accurate survival estimation is crucial for understanding the true impact of meningioma disease on patient longevity.
Purpose of the Study:
- To accurately assess survival rates after meningioma surgery using a method that accounts for competing risks.
- To identify factors influencing relative survival (RS) in patients who underwent meningioma surgery.
Main Methods:
- Utilized the French national health data system (Système National des Données de Santé) for patient data.
- Included 28,778 patients surgically treated for meningioma between 2007 and 2017.
- Employed the Pohar Perme relative survival (RS) method for analysis.
Main Results:
- The five-year relative survival rate was 96.2% (95% CI [95.7-96.8]), indicating a 1.8 times higher mortality risk compared to the general population.
- Key independent predictors of reduced relative survival included male gender, older age at surgery, neurofibromatosis type 2, comorbidities, specific tumor locations, pre-operative embolization, CSF shunt, atypical or malignant histology, redo surgery, and radiotherapy.
- Absolute excess mortality risk was 973/100,000 person-years.
Conclusions:
- Meningioma surgery is associated with significant excess mortality, underscoring the disease's impact beyond surgical outcomes.
- Relative survival is influenced by a complex interplay of patient demographics (gender, age), tumor characteristics (histology, location), and treatment modalities (surgery, radiotherapy, embolization).
