Unsuccessful external validation of the MAC-score for predicting increased MIB-1 index in patients with spinal meningiomas

Abstract

ObjectiveRecently, the MAC-spinal meningioma score (MAC-score) was proposed to preoperatively identify spinal meningioma patients with high MIB-1 indices. Risk factors were age ≥ 65 years, a modified McCormick score (mMCs) ≥ 2, and absence of tumor calcification. The aim of this study was to externally validate the MAC-score in an independent cohort.MethodsUsing the same inclusion and exclusion criteria as in the original study, we performed a retrospective, single-center, population-based, cohort study that included patients who had undergone surgical treatment for spinal meningiomas between 2005 – 2017. Data was collected from patient charts and radiographic images. Validation was performed by applying the MAC-score to our cohort and evaluating the area under the receiver operating characteristic curve (AUC).ResultsIn total, 108 patients were included. Baseline and outcome data were comparable to the original development study. An increased MIB-1 index (≥5%) was observed in 56 (52%) patients. AUC of the MAC-score in our validation cohort was 0.61 (95% CI: 0.51 – 0.71), which corresponds to a poor discriminative ability.ConclusionThe MAC-score showed poor discriminative ability for MIB-1 index prediction in patients with spinal meningiomas. Moreover, the MAC-score rests on a weak theoretical and statistical foundation. Consequently, we argue against its clinical implementation.

Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1)

“…Although frequent among intradural tumors, spinal meningiomas only make up a fraction of all meningiomas, as they are 10 to 50 times less prevalent than their intracranial counterparts [ 1 , 2 , 3 ]. The majority of spinal meningiomas are benign WHO grade 1 tumors [ 4 , 5 , 6 , 7 ] that primarily affect elderly women [ 4 , 6 ]. Most of these tumors are sporadic, but there is a known genetic link to neurofibromatosis type 2 (NF2), and exposure to ionizing radiation is a known predisposing factor [ 1 , 8 ].…”

Current Knowledge on Spinal Meningiomas—Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2)

“…It is well-established that surgery is the preferred treatment of choice for spinal meningiomas [ 1 ], as tumor removal usually relieves symptoms with little risk for complications or recurrence and a high frequency of postoperative improvement [ 2 , 3 , 4 ]. Cerebrospinal fluid leak, transitory or permanent neurological impairments, and infections are the most commonly reported complications, while pulmonary embolisms were behind most of the fatalities [ 2 , 3 , 5 , 6 , 7 ].…”

Long-Term Functional Outcomes Following Surgical Treatment of Spinal Schwannomas: A Population-Based Cohort Study

“…Thus, while meningiomas generally cause myelopathic symptoms related to spinal cord compression, schwannomas may more commonly present with symptoms related to nerve root compression. In addition, schwannomas are typically soft tumors that exhibit cystic degeneration, as opposed to meningiomas which are commonly denser and associated with intratumoral calcifications [30].…”