Nonmalignant and malignant meningioma incidence and survival in the elderly, 2005–2015, using the Central Brain Tumor Registry of the United States

Abstract

Background. Meningioma incidence increases significantly with age. In the expanding elderly population, we lack complete understanding of population-based trends in meningioma incidence/survival. We provide an updated, comprehensive analysis of meningioma incidence and survival for individuals aged over 65. Methods. Data were obtained from the Central Brain Tumor Registry of the United States (CBTRUS) from 2005-2015 for nonmalignant and malignant meningioma. Age-adjusted incidence rates per 100 000 person-years were analyzed by age, sex, race, ethnicity, location, and treatment modalities. Survival was analyzed using Kaplan-Meier and multivariable Cox proportional hazards models for a subset of CBTRUS data. Results. Nonmalignant meningioma incidence doubled from adults age 65-69 years to adults over age 85 years and was significantly greater in females than males for all ages. Malignant meningioma incidence did not differ by sex for any age grouping. Nonmalignant and malignant meningioma incidence was significantly greater in black populations versus others. Nonmalignant meningioma survival was worse with age, in black populations, and in males, including when analyzed by 5-year age groups. Surgical resection and radiation did not improve survival compared with resection alone in nonmalignant meningioma. Conclusions. This study reports increasing nonmalignant meningioma incidence in the elderly, increased incidence in black populations, and in females. In contrast, malignant meningioma incidence did not differ between sexes. Risk of death was higher for black individuals and males. Additionally, radiation did not confer a survival advantage when combined with resection for nonmalignant meningioma. Thus, we identify clinically relevant discrepancies in meningioma incidence/survival that require further study. Key Points 1. Meningioma incidence is highest in black populations, females, and increasingly the elderly 2. Nonmalignant meningioma survival is lowest in black populations, males, and increasingly the elderly 3. Adjuvant radiation following surgical resection does not confer a survival advantage in the elderly 381 Achey et al. Nonmalignant and malignant meningioma incidence and survival in the elderly Neuro-Oncology Meningioma is the most common primary neoplasm of the central nervous system (CNS), accounting for 36.4% of CNS tumors reported from 2010 to 2014. 1 According to a recent study, nonmalignant meningioma has an incidence rate (IR) of 7.86 per 100 people; a rate that has significantly increased from 2004 to 2010, with an annual percentage change (APC) of 3%. 2 A report of atypical, World Health Organization (WHO) grade II meningioma revealed increasing incidence in 2004-2010, with a 3.6% APC. 3 In fact, an estimated 29 320 new meningioma diagnoses are projected in the United States for 2018 alone. 1 Furthermore, there is clear evidence that incidence of meningioma increases with age, with a median age at diagnosis of 66 years old. 1,4 However, few studies have taken a comprehensive approach to the d...

Inequalities in Meningioma Survival: Results from the National Cancer Database

“…Our data demonstrated that Asian patients had a decreased hazard of death compared with white patients, whereas black patients had an increased hazard of death in the univariate analysis [13]. Black race has been reported to be a negative prognosticator of outcomes in several of the aforementioned studies [1,3,10]. Notably, Achey et al included white, black, and Asian/pacific islanders in their study and found that black patients had the worst outcomes [1].…”

“…Black race has been reported to be a negative prognosticator of outcomes in several of the aforementioned studies [1,3,10]. Notably, Achey et al included white, black, and Asian/pacific islanders in their study and found that black patients had the worst outcomes [1]. Furthermore, Cahill and Claus reported that black patients were less likely to undergo surgical treatment, which was a positive predictor in their multivariate model [3].…”

“…In an analysis of 12,284 patients from the Surveillance, Epidemiology, and End Results (SEER) database, Cahill and Claus also reported a decreased hazard of death in female patients with non-malignant intracranial meningiomas [3]. Based on data from the Central Brain Tumor Registry of the United States, Achey et al likewise found a survival benefit in females in non-malignant meningiomas [1]. On the contrary, other studies did not find differences in outcomes based on sex [4,8].…”

“…Our data showed that Hispanic patients had a decreased hazard of death compared with non-Hispanics. In the aforementioned studies, there were no difference in outcomes between Hispanics and non-Hispanics [1,4,8] However, favorable outcomes in Hispanic patients have been reported for other primary CNS tumors; for example, Farah et al demonstrated increased survival rates in Hispanics in a cohort of 33,204 patients with glioblastoma [11]. Similar observations have led to the term "Hispanic paradox," whereby Hispanic patients experience better outcomes despite lower socioeconomic status and decreased access to healthcare.…”

“…Meningiomas account for 30% of all primary central nervous system (CNS) tumors, with an incidence of 20-40 per 100,000 person-years [1,2]. There are several known predictors of outcomes in meningiomas, including patient age, tumor size or laterality, and surgical resection [1,3,4]. However, there is a paucity of literature examining how healthcare, demographic, socioeconomic factors may impact survival in meningioma patients.…”