노인 뇌수막종 수술에서 합병증 예측에 대한 스코어링 시스템의 비교

Abstract

Background : Grading systems such as the Clinical-Radiological Grading System (CRGS), Geriatric Scoring System (GSS), and SKALE (sex, KPS [Karnofsky Performance Scale], American Society of Anesthesiology class, location of tumor, and peritumoral edema) grading system are useful for predicting outcomes in meningioma patients over 65 years. Given the increase in average life expectancy, it is required to identify the most effective grading system, which would help anticipate postoperative complications, as well as other risk factors, especially in elderly patients aged over 75 years. Materials and Methods : Scores were calculated retrospectively according to CRGS, SKALE, and GSS for patients aged over 75 years who underwent surgery for intracranial meningiomas in our hospital from 2009 to 2020 (n = 88). Various perioperative clinical and radiological factors were also measured to investigate their relationship with surgical complications. Results : In the 88 patients enrolled, the complication rate was 28.4% (n = 25), including three mortality cases (3.4%). Multivariate analysis of various risk factors revealed that peritumoral edema (P = 0.011), tumor location (P = 0.001), and KPS (P = 0.030) were independent prognostic factors for the development of postoperative complications. Despite slight differences in cut-off values, patients with SKALE ≥ 11 (area under the curve [AUC] = 0.7038), CRGS ≥ 14 (AUC = 0.7441), and GSS ≥ 17 (AUC = 0.7829) showed decreased rates of complications on ROC (receiver operating characteristic) curve analysis. Conclusions : In our study, with the slight modification of cut-off values, all three scoring systems were powerful predictors of postoperative complications in intracranial meningioma resection of elderly patients aged over 75 years.