Meningioma Surgery in Patients ≥70 Years of Age: Clinical Outcome and Validation of the SKALE Score

Abstract

Along with increasing average life expectancy, the number of elderly meningioma patients has grown proportionally. Our aim was to evaluate whether these specific patients benefit from surgery and to investigate a previously published score for decision-making in meningioma patients (SKALE). Of 421 patients who underwent primary intracranial meningioma resection between 2009 and 2015, 71 patients were ≥70 years of age. We compared clinical data including World Health Organization (WHO) grade, MIB-1 proliferation index, Karnofsky Performance Status Scale (KPS), progression free survival (PFS) and mortality rate between elderly and all other meningioma patients. Preoperative SKALE scores (Sex, KPS, ASA score, location and edema) were determined for elderly patients. SKALE ≥8 was set for dichotomization to determine any association with outcome parameters. In 71 elderly patients (male/female 37/34) all data were available. Postoperative KPS was significantly lower in elderly patients (p < 0.0001). Pulmonary complications including pneumonia (10% vs. 3.2%; p = 0.0202) and pulmonary embolism (12.7% vs. 6%; p = 0.0209) occurred more frequently in our elderly cohort. Analyses of the Kaplan Meier curves revealed differences in three-month (5.6% vs. 0.3%; p = 0.0033), six-month (7% vs. 0.3%; p = 0.0006) and one-year mortality (8.5% vs. 0.3%; p < 0.0001) for elderly patients. Statistical analysis showed significant survival benefit in terms of one-year mortality for elderly patients with SKALE scores ≥8 (5.1 vs. 25%; p = 0.0479). According to our data, elderly meningioma patients face higher postoperative morbidity and mortality than younger patients. However, resection is reasonable for selected patients, particularly when reaching a SKALE score ≥ 8.

Meningioma in the elderly

“…Multidisciplinary evaluation for patients with medical concerns, careful patient selection, minimally invasive approaches, and optimized perioperative care may reduce this excess risk and produce outcomes similar to younger cohorts. 41 , 58 , 63–65 , 67–70 , 72 , 76–78 Increased consideration of these factors may explain a lower rate of adverse events in elderly patients in more recent surgical series. 65 Multiple scoring systems have been proposed to aid in preoperative risk stratification of elderly patients, but there is insufficient evidence of their validity to support their routine use.…”

“…Increasing age at diagnosis is associated with progressive shortening of overall survival in the elderly when all meningioma grades are considered, 5 , 13 , 63 , 66 , 72 , 86 but the specific impact of low-grade meningiomas on overall survival is not well described. 5 PFS in the elderly is likely to be comparable to younger patients if successful resection is possible 17 , 76 and thus the reduced overall survival may not be tumor related.…”

Pulmonary embolism following the third thoracic tuberculosis surgery: A case report and literature review

“…The elderly population is more susceptible to pulmonary embolism after the surgical treatment than the younger age group. 29 It was also evident that the mortality rates increased with the advancing age. 30 A study by Zhou et al showed that hypertensive patients older than 60 years were more prone to pulmonary embolism, 31 which might be attributable to the hypercoagulable state of elder patients with hypertension.…”

“… 32 The patient in this case report was 74 years old and had a slightly higher blood pressure during the entire hospitalization, which was consistent with the results of previous studies. 29 , 30 , 31 , 32 …”

A Clinical Prognostic Model Based on Preoperative Hematological and Clinical Parameters Predicts the Progression of Primary WHO Grade II Meningioma

“…Recent studies have confirmed that PTBE is associated with the WHO classification and invasiveness of meningiomas ( 43 , 44 ). The SKALE scoring decision-making system, which includes PTBE and other parameters, has been demonstrated to be related to postoperative progression rate of meningiomas ( 45 ). Our study also confirmed that PTBE was an independent risk factor for the progression of AM.…”