Epidemiology and Survival after Spinal Meningioma Surgery: A Nationwide Population-Based Study

Abstract

Study Design: This is a cross-sectional nationwide descriptive observational and analytic retrospective study. Purpose: This study aims to describe and assess survival after spinal meningioma (SM) surgery. Overview of Literature: A few studies report a reduced survival after SM surgery. Methods: The current study processed the Système National des Données de Santé (SNDS), the French national administrative medical database, to retrieve appropriate cases. Results: This study identified 2,844 patients (79.1% females) between 2008 and 2017. The median age at surgery was 66 years (interquartile range [IQR], 56–75 years). Moreover, 95.9% of SMs were removed through posterior or posterolateral approaches, and 6.9% were epidural and 0.7% needed an associated spine stabilization. Benign meningioma represented 92.9%, with 5% and 2.1% atypical and malignant, respectively. The median follow-up was 3.3 years (IQR, 3.1–3.5 years). Of the patients, 0.25% and 1.2% expired within a month and a year of surgery, respectively. At data collection, 225 patients (7.9%) expired. The 5-year overall survival (OS) probability was 90.1% (95% CI, 88.6%–91.7%). However, absolute excess risk of mortality after SM surgery was null, and the related standardized mortality ratio was 1 (95% CI, 0.9–1.2; p =0.565). In the adjusted regression, age at surgery (hazard ratio [HR], 1.06; 95% CI, 1.04–1.07; p <0.001), level of comorbidities (HR, 1.44; 95% CI, 1.34–1.54; p <0.001), neurofibromatosis type 2 (NF2; HR, 3.65; 95% CI, 1.28–10.39; p =0.0152), epidural SM (HR, 1.73; 95% CI, 1.09–2.75; p =0.0206), and malignant meningioma (HR, 2.64; 95% CI, 1.51–4.61; p <0.001) remained significantly associated to a reduced OS. Conclusions: The SNDS is of great value in assessing SM incidence, associated mortality, and its predictors. OS after meningioma surgery is favorable but may be impaired for NF2 or older patients with a high level of comorbidities, epidural tumor, and malignant histopathology. SM surgery is not associated with an increased absolute excess mortality risk despite being performed on even more senior patients compared with intracranial meningioma.