Model of prognostic monitoring of patients with asymptomatic meningioma found by chance

With the development of neuroimaging technology and the popularization and application of examination methods, the detection rate of asymptomatic meningioma is increasingAbdurrahman IIslim of the University of Liverpool's Institute of Translational Medicine, among others, used to develop prognostic models to assess disease progression by analyzing clinical and imaging data from patients with asymptomatic meningioma, published in the February 2020 issue of The Journal of Neuro-Oncologyresearch methods
the study retrospectively analyzed data on 441 patients with meningioma from 2007 to 2015 and designed a prognostic model; Secondary prognostic indicators include fatality rates due to non-meningioma441 cases of meningioma, 426 single tumor cases, 15 cases of multiple cases, a total of 459 meningioma; The overall median follow-up time is 55.0 months (IQR 37.0-80.0)Follow-up found 44 cases (11.4%) of meningioma progressionThe final prognostic indicator showed 29 tumor growth, 12 new symptoms, 10 CASEs of MRI imaging showing changes in signals around the tumor, and 2.4% of tumor volume slonging from the initial 10cm3 to 10cm3 and invading the sinusesNew symptoms include 6 seizures, 3 cases of exercise difficulties, 2 cases of vision impairment and 1 case of comorbiditiesMedian survival time was 33.0 months (IQR 15.0-46.5) in patients in the disease progressgroupThe five-year and 10-year progress-free survival rates were 83.0% (95% CI, 77.1-88.9) and 70.0% (95% CI, 56.3-83.7), respectivelyThe volume of meningiomas in thedisease progression group and the disease stabilization group changed over timeThe disease progression group meningioma is exponentialAt the same time two tumors of equal size, the disease progression group's meningioma reaches the end of the disease's progression after 6 yearsThe intervention rate of the Disease Stability Group was significantly lower than that of the Disease Progress Group (P 0.001)20 (45.5%) patients in the disease progressgroup and 18 (5.01) patients in the disease stabilization group were treated In the disease progressgroup group, 5 cases were given anti-epileptic drugs, of which 3 were well controlled and 2 cases of tumor growth were good the authors build a prognostic model for patients with asymptomatic meningioma based on the results of the analysis Model 1 uses the multilinear backward regression method to clearly affect the prognosis of meningioma patients with high signal and tumor volume of MRI-T2 or FLAIR weighted sequence Model 2 used the signalaround around the tumor and the adjacent important neurovascular structure as risk factors affecting the patient's prognosis calculate the prognosis index and plot the histogram of the frequency distribution of disease progression groups and stabilization groups according to Model 2, and set up three different risk groups, low risk groups (1), medium risk groups (3) and high-risk groups ( s3) Kaplan-Meier analysis showed that the difference in tumor non-progressive survival between different risk groups was statistically significant (P 0.001) (Figure 1) Figure 1 A Using prognosis index, MRI high signal, away from important nerve blood vessels, tumor volume 1.50cm3, no changeins in the tumor around the signal convex meningioma, classified as a medium risk group B The frequency distribution histogram of the disease progressgroup and the prognosis index of the disease stabilization group C, D No progression survival rate of tumors between different risk groups risk stratification based on age-adjusted Charlton Comorbidity Index (ACI), the difference in intervention rates between different risk groups was statistically significant (P 0.001) (Figure 2), and there was no significant difference in disease progression rates (P-0.090) Within a five-year follow-up period after the first consultation, the mortality rate was 15 times higher among patients with non-interventional ACCI-6 than in patients who received the intervention The progression rate of the disease was three times higher in patients with ACCI 0-2 than in patients with ACCI s6 In ACCI 3-5 patients, there was no significant difference in intervention rates and mortality rates between groups Risk stratification was found to be statistically significant (P 0.001) between different risk groups, according to the patient's functional performance (performance status, PS) Patients with a PS score of 2-4 had no progressors with disease and no intervention There was no significant difference in intervention rates and mortality rates between groups of PS-0-1 patients (Figure 2) Figure 2 A, B The cumulative risk curve (solid) and 95% CI (shadow) based on the disease progression of ACCI and PS stratification and their competitive events C, D Intervention rate and mortality curves (solid lines) and 95% CI (shadow) based on ACCI and PS stratification divided patients with accidentally discovered asymptomatic meningioma into 5 groups based on clinical and imaging risk factors (Figure 3) Low- and critically ill patients with ACCI 6 and PS 0-1 can be discharged from hospital for observation without clinical or imaging monitoring, but should be informed of the symptoms requiring review The remaining 4 categories of patients were monitored Imaging follow-up for high-risk patients with ACCI or PS of 2-4 Low, medium and high-risk patients establish different follow-up points according to the progress of the disease, and develop individualized treatment or follow-up programs by assessing tumor growth, disease progression, tumor peripheral signals, relationship with peripheral nerve vessels, and treatment timing Figure 3 Individualized monitoring of patients with asymptomatic meningiomas found by chance The green box is the recommended follow-up time ACCI 0-2: Young patients with virtually no comorbidities; 3-5: older patients without comorbidities or young patients with severe comorbidities; and older patients with comorbidities PS 0-1: Patients with normal or mild symptoms; conclusions the results show that most patients with asymptomatic meningioma found by chance were relatively stable during follow-up and entered a stable period after 5 years of follow-up High signals, increased volume, adjacent meningiomas with important neurovascular structures and changes in signals around the tumor can increase the risk of disease progression within 5 years In making the decision-making, we should consider the change of imaging characteristics, age, comorbidities and physical function status Based on the above results, the researchers developed a free online tool, the IMPACT calculator, which provides prognostic assessment and risk stratification of comorbidities and MRI results in patients with asymptomatic meningioma, and determines the need for follow-up and the frequency of imaging examinations, helping to reduce anxiety and control medical costs.