gms | German Medical Science

Objective: To analyze recurrence and mortality after meningioma surgery in the elderly (≥65 years) and to compare survival with case-control studies including elderlies without meningiomas.

Methods: Prognostic value of clinical and histopathological data in 500 patients (162 elderly and 338 younger, median follow-up: 90 months) who underwent surgery for primary diagnosed meningioma between 1994 and 2009 were analyzed in uni- and multivariate analyses. Mortality was compared with average life expectancy in Germany in each case.

Results: Percentage of surgeries in individuals of 65 years and elder raised from 27% in the first to 30% in the second and up to 38% in the last five years of the inclusion period. Median age at diagnosis among the elderly and younger patients was 71 and 51 years, respectively. Female-male ratio, intracranial tumor location, grade of resection, radiotherapy and histopathological subtypes were similar comparing younger and elderly patients. High grade (WHO °II and III) and spinal tumors were more common in elderly as compared to younger patients (15% vs. 8%, p=.017 and 12% vs. 4%, p=.001, respectively). Although progression free interval (PFI) was similar in both groups, mortality at 3 months and at 5 and 10 years after surgery was higher and median OS was shorter in elder (7, 14 and 19%; 191 month) than in younger patients (1, 3 and 5%, median not reached; HR: 4.9, 95%CI 2.75-8.74; p<.001). However, median OS in elderly patients did not differ from the anticipated average life expectancy of age- and sex-matched controls. In elderly patients, rate of recurrence was 3-times higher in male (21%; N=10/74) than in female patients (6%; N=6/96; p=.011) and mean PFI was correspondingly lower in males (p=.014, medians not reached). Grade II and III meningiomas were found to be more common in males (24%, N=12/50) than in females (11%, 12/112, p=.034). Moreover, PFI was lower in high grade meningiomas (HR: 24.74, 95%CI 4.23-144.66; p<.001) and after subtotal resection (HR: 10.57, 95%CI 2.23-50.05; p=.003) but grade of resection was not correlated with mortality. PFI was shorter in elderly patients suffering from recurrent meningioma relapse (HR: 5.78, 95%CI 1.28-25.24; p=.023)..

Conclusion: Mortality after surgery for meningioma in the elderly is higher than in younger patients but comparable to average LE. Maximum achievable resection should be strived as it prolongs PFI and does not impact mortality.