TY - JOUR

T1 - The importance of considering competing risks in recurrence analysis of intracranial meningioma

AU - Mirian, Christian

AU - Jensen, Lasse Rehné

AU - Juratli, Tareq A.

AU - Maier, Andrea Daniela

AU - Torp, Sverre H.

AU - Shih, Helen A.

AU - Morshed, Ramin A.

AU - Young, Jacob S.

AU - Magill, Stephen T.

AU - Bertero, Luca

AU - Stummer, Walter

AU - Spille, Dorothee Cäcilia

AU - Brokinkel, Benjamin

AU - Oya, Soichi

AU - Miyawaki, Satoru

AU - Saito, Nobuhito

AU - Proescholdt, Martin

AU - Kuroi, Yasuhiro

AU - Gousias, Konstantinos

AU - Simon, Matthias

AU - Moliterno, Jennifer

AU - Prat-Acin, Ricardo

AU - Goutagny, Stéphane

AU - Prabhu, Vikram C.

AU - Tsiang, John T.

AU - Wach, Johannes

AU - Güresir, Erdem

AU - Yamamoto, Junkoh

AU - Kim, Young Zoon

AU - Lee, Joo Ho

AU - Koshy, Matthew

AU - Perumal, Karthikeyan

AU - Baskaya, Mustafa K.

AU - Cannon, Donald M.

AU - Shrieve, Dennis C.

AU - Suh, Chang Ok

AU - Chang, Jong Hee

AU - Kamenova, Maria

AU - Straumann, Sven

AU - Soleman, Jehuda

AU - Eyüpoglu, Ilker Y.

AU - Catalan, Tony

AU - Lui, Austin

AU - Theodosopoulos, Philip V.

AU - McDermott, Michael W.

AU - Wang, Fang

AU - Guo, Fuyou

AU - Góes, Pedro

AU - de Paiva Neto, Manoel Antonio

AU - Jamshidi, Aria

AU - Komotar, Ricardo

AU - Ivan, Michael

AU - Luther, Evan

AU - Souhami, Luis

AU - Guiot, Marie Christine

AU - Csonka, Tamás

AU - Endo, Toshiki

AU - Barrett, Olivia Claire

AU - Jensen, Randy

AU - Gupta, Tejpal

AU - Patel, Akash J.

AU - Klisch, Tiemo J.

AU - Kim, Jun Won

AU - Maiuri, Francesco

AU - Barresi, Valeria

AU - Tabernero, María Dolores

AU - Skyrman, Simon

AU - Broechner, Anders

AU - Bach, Mathias Jacobsen

AU - Law, Ian

AU - Scheie, David

AU - Kristensen, Bjarne Winther

AU - Munch, Tina Nørgaard

AU - Meling, Torstein

AU - Fugleholm, Kåre

AU - Blanche, Paul

AU - Mathiesen, Tiit

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2024

Y1 - 2024

N2 - Background: The risk of recurrence is overestimated by the Kaplan–Meier method when competing events, such as death without recurrence, are present. Such overestimation can be avoided by using the Aalen-Johansen method, which is a direct extension of Kaplan–Meier that accounts for competing events. Meningiomas commonly occur in older individuals and have slow-growing properties, thereby warranting competing risk analysis. The extent to which competing events are considered in meningioma literature is unknown, and the consequences of using incorrect methodologies in meningioma recurrence risk analysis have not been investigated. Methods: We surveyed articles indexed on PubMed since 2020 to assess the usage of competing risk analysis in recent meningioma literature. To compare recurrence risk estimates obtained through Kaplan–Meier and Aalen-Johansen methods, we applied our international database comprising ~ 8,000 patients with a primary meningioma collected from 42 institutions. Results: Of 513 articles, 169 were eligible for full-text screening. There were 6,537 eligible cases from our PERNS database. The discrepancy between the results obtained by Kaplan–Meier and Aalen-Johansen was negligible among low-grade lesions and younger individuals. The discrepancy increased substantially in the patient groups associated with higher rates of competing events (older patients with high-grade lesions). Conclusion: The importance of considering competing events in recurrence risk analysis is poorly recognized as only 6% of the studies we surveyed employed Aalen-Johansen analyses. Consequently, most of the previous literature has overestimated the risk of recurrence. The overestimation was negligible for studies involving low-grade lesions in younger individuals; however, overestimation might have been substantial for studies on high-grade lesions.

AB - Background: The risk of recurrence is overestimated by the Kaplan–Meier method when competing events, such as death without recurrence, are present. Such overestimation can be avoided by using the Aalen-Johansen method, which is a direct extension of Kaplan–Meier that accounts for competing events. Meningiomas commonly occur in older individuals and have slow-growing properties, thereby warranting competing risk analysis. The extent to which competing events are considered in meningioma literature is unknown, and the consequences of using incorrect methodologies in meningioma recurrence risk analysis have not been investigated. Methods: We surveyed articles indexed on PubMed since 2020 to assess the usage of competing risk analysis in recent meningioma literature. To compare recurrence risk estimates obtained through Kaplan–Meier and Aalen-Johansen methods, we applied our international database comprising ~ 8,000 patients with a primary meningioma collected from 42 institutions. Results: Of 513 articles, 169 were eligible for full-text screening. There were 6,537 eligible cases from our PERNS database. The discrepancy between the results obtained by Kaplan–Meier and Aalen-Johansen was negligible among low-grade lesions and younger individuals. The discrepancy increased substantially in the patient groups associated with higher rates of competing events (older patients with high-grade lesions). Conclusion: The importance of considering competing events in recurrence risk analysis is poorly recognized as only 6% of the studies we surveyed employed Aalen-Johansen analyses. Consequently, most of the previous literature has overestimated the risk of recurrence. The overestimation was negligible for studies involving low-grade lesions in younger individuals; however, overestimation might have been substantial for studies on high-grade lesions.

KW - Competing risk

KW - Meningioma

KW - Neuro-oncology

KW - Recurrence

U2 - 10.1007/s11060-024-04572-y

DO - 10.1007/s11060-024-04572-y

M3 - Journal article

C2 - 38336917

AN - SCOPUS:85184891124

SP - 503

EP - 511

JO - Journal of Neuro-Oncology

JF - Journal of Neuro-Oncology

SN - 0167-594X

ER -