Supervised machine learning algorithms demonstrate proliferation index correlates with long-term recurrence after complete resection of WHO grade I meningioma.
Supervised machine learning algorithms demonstrate proliferation index correlates with long-term recurrence after complete resection of WHO grade I meningioma.
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DOI：
10.3171/2022.4.jns212516
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发表时间：
2023-01-01
影响因子：
4.1
通讯作者：
Theodosopoulos, Philip, V
中科院分区：
文献类型：
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作者：
Nguyen, Minh P.;Morshed, Ramin A.;Ore, Cecilia L. Dalle;Cummins, Daniel D.;Saggi, Satvir;Chen, William C.;Choudhury, Abrar;Ravi, Akshay;Raleigh, David R.;Magill, Stephen T.;McDermott, Michael W.;Theodosopoulos, Philip, V
脑膜瘤是最常见的原发性颅内肿瘤，切除是主要的治疗方法。目前尚不清楚WHO I级脑膜瘤完全切除后的影像学随访时间是合理的。本研究检查了WHO I级脑膜瘤完全切除（根据术后MRI和术中印象定义）患者的复发率、复发时间和复发风险因素。作者进行了一项回顾性、单中心研究，检查了接受完全切除术的单个颅内脑膜瘤成人患者的复发风险。进行单因素和多因素名义逻辑回归和考克斯比例风险分析，以确定与复发和复发时间相关的变量。然后实施了两种监督机器学习算法，以确认队列中与复发相关的因素。该队列包括823例符合入选标准的患者，56例患者（6.8%）在影像学随访时复发。队列的中位年龄为56岁，77.4%的患者为女性。整个队列的头部成像随访的中位持续时间为2.7年，但对于复发患者亚组，中位随访时间为10.1年。估计1年、5年、10年和15年无复发生存率为99.8%（95%置信区间[CI] 98.8%-99.9%），91.0%（95% CI 87.7%-93.6%）、83.6%（95% CI 78.6%-87.6%）和77.3%（95% CI 69.7%-83.4%）。在多变量分析中，MIB-1指数（每增加1%的比值比[OR]：1.34，95% CI 1.13-1.58，p = 0.0003）和随访时间（每年OR：1.12，95% CI 1.03-1.21，p = 0.012）均与复发相关。除影像学随访时间外，增强决策树和随机森林分析均将MIB-1指数确定为与复发相关的主要因素。对于MIB-1指数< 8的肿瘤，术后8年内记录复发。对于MIB-1指数≥ 8的肿瘤，记录了术后12年的复发。即使在脑膜瘤完全切除后，长期影像学随访也很重要。MIB-1标记指数越高，复发风险越大。对于MIB-1指数< 8的患者，可能需要进行至少8年的影像学筛查，对于MIB-1指数≥ 8的患者，可能需要进行至少12年的影像学筛查，以检测长期复发。
Meningiomas are the most common primary intracranial tumor, and resection is a mainstay of treatment. It is unclear what duration of imaging follow-up is reasonable for WHO grade I meningiomas undergoing complete resection. This study examined recurrence rates, timing of recurrence, and risk factors for recurrence in patients undergoing a complete resection (as defined by both postoperative MRI and intraoperative impression) of WHO grade I meningiomas. The authors conducted a retrospective, single-center study examining recurrence risk for adult patients with a single intracranial meningioma that underwent complete resection. Uni- and multivariate nominal logistic regression and Cox proportional hazards analyses were performed to identify variables associated with recurrence and time to recurrence. Two supervised machine learning algorithms were then implemented to confirm factors within the cohort that were associated with recurrence. The cohort consisted of 823 patients who met inclusion criteria, and 56 patients (6.8%) had recurrence on imaging follow-up. The median age of the cohort was 56 years, and 77.4% of patients were female. The median duration of head imaging follow-up for the entire cohort was 2.7 years, but for the subgroup of patients who had a recurrence, the median follow-up was 10.1 years. Estimated 1-, 5-, 10-, and 15-year recurrence-free survival rates were 99.8% (95% confidence interval [CI] 98.8%–99.9%), 91.0% (95% CI 87.7%–93.6%), 83.6% (95% CI 78.6%–87.6%), and 77.3% (95% CI 69.7%–83.4%), respectively, for the entire cohort. On multivariate analysis, MIB-1 index (odds ratio [OR] per 1% increase: 1.34, 95% CI 1.13–1.58, p = 0.0003) and follow-up duration (OR per year: 1.12, 95% CI 1.03–1.21, p = 0.012) were both associated with recurrence. Gradient-boosted decision tree and random forest analyses both identified MIB-1 index as the main factor associated with recurrence, aside from length of imaging follow-up. For tumors with an MIB-1 index < 8, recurrences were documented up to 8 years after surgery. For tumors with an MIB-1 index ≥ 8, recurrences were documented up to 12 years following surgery. Long-term imaging follow-up is important even after a complete resection of a meningioma. Higher MIB-1 labeling index is associated with greater risk of recurrence. Imaging screening for at least 8 years in patients with an MIB-1 index < 8 and at least 12 years for those with an MIB-1 index ≥ 8 may be needed to detect long-term recurrences.