Determinants and predictors for the long-term disease burden of intracranial meningioma patients

Linda Dirven,Martin Klein,Florien Boele ,Wouter R. van Furth,Saskia M. Peerdeman,Martin J.b. Taphoorn ,Amir H Zamanipoor Najafabadi ,Pim B Van Der Meer

doi:10.1007/s11060-020-03650-1

Abstract

IntroductionMeningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae. To help identify patients at risk for these late effects, we first assessed variables associated with impaired long-term health-related quality of life (HRQoL) and impaired neurocognitive function on group level (i.e. determinants). Next, prediction models were developed to predict the risk for long-term neurocognitive or HRQoL impairment on individual patient-level.MethodsSecondary data analysis of a cross-sectional multicenter study with intracranial WHO grade I/II meningioma patients, in which HRQoL (Short-Form 36) and neurocognitive functioning (standardized test battery) were assessed. Multivariable regression models were used to assess determinants for these outcomes corrected for confounders, and to build prediction models, evaluated with C-statistics.ResultsData from 190 patients were analyzed (median 9 years after intervention). Main determinants for poor HRQoL or impaired neurocognitive function were patients’ sociodemographic characteristics, surgical complications, reoperation, radiotherapy, presence of edema, and a larger tumor diameter on last MRI. Prediction models with a moderate/good ability to discriminate between individual patients with and without impaired HRQoL (C-statistic 0.73, 95% CI 0.65 to 0.81) and neurocognitive function (C-statistic 0.78, 95%CI 0.70 to 0.85) were built. Not all predictors (e.g. tumor location) within these models were also determinants.ConclusionsThe identified determinants help clinicians to better understand long-term meningioma disease burden. Prediction models can help early identification of individual patients at risk for long-term neurocognitive or HRQoL impairment, facilitating tailored provision of information and allocation of scarce supportive care services to those most likely to benefit.

Highlights

Meningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae
Results of this study indicate that determinants for the longterm disease burden in meningioma patients on group level are (1) sociodemographic characteristics: sex, age and educational level, (2) treatment characteristics: complications of surgery, reoperation, radiotherapy, (3) tumor characteristics: diameter and peritumoral edema at the time of study, and (4) clinician-reported level of functioning (i.e. Karnofsky Performance Score (KPS))
We have developed prediction models to predict whether an individual patient will suffer from long-term health-related quality of life (HRQoL) or neurocognitive impairment using accessible patient chart information, which showed moderate to good discriminative ability to differentiate between those with and without clinically relevant impairments in HRQoL or neurocognitive function on the long term

Summary

Introduction

Meningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae. To help identify patients at risk for these late effects, we first assessed variables associated with impaired longterm health-related quality of life (HRQoL) and impaired neurocognitive function on group level (i.e. determinants). Prediction models can help early identification of individual patients at risk for long-term neurocognitive or HRQoL impairment, facilitating tailored provision of information and allocation of scarce supportive care services to those most likely to benefit. Early identification of patients at high risk for a long-term disease burden facilitates timely provision of information and rehabilitation, and allocation of scarce supportive care services to those most likely to obtain benefit. There are no published studies on the possible factors associated with the long-term disease burden (≥ 5 years) This distinction is important as patients might suffer from different issues during the treatment phase, they do on the longer term (i.e. survivorship issues). On the long-term patients might face growth of tumor remnant or recurrence of disease, sometimes requiring intervention [13]

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