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.

中文翻译：

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在颅内脑膜瘤复发分析中考虑竞争风险的重要性

背景

当存在竞争事件（例如未复发的死亡）时，Kaplan-Meier 方法会高估复发风险。使用 Aalen-Johansen 方法可以避免这种高估，该方法是考虑竞争事件的 Kaplan-Meier 方法的直接扩展。脑膜瘤通常发生在老年人中，并且具有生长缓慢的特性，因此需要进行竞争性风险分析。脑膜瘤文献中考虑竞争事件的程度尚不清楚，并且尚未调查在脑膜瘤复发风险分析中使用不正确方法的后果。

方法

我们调查了自 2020 年以来 PubMed 上索引的文章，以评估竞争风险分析在最新脑膜瘤文献中的使用情况。为了比较通过 Kaplan-Meier 和 Aalen-Johansen 方法获得的复发风险估计值，我们应用了我们的国际数据库，该数据库包含从 42 个机构收集的约 8,000 名原发性脑膜瘤患者。

结果

在 513 篇文章中，有 169 篇符合全文筛选条件。我们的PERNS数据库中有 6,537 个符合条件的案例。在低级别病变和年轻个体中，Kaplan-Meier 和 Aalen-Johansen 获得的结果之间的差异可以忽略不计。在与竞争事件发生率较高相关的患者组（具有高级别病变的老年患者）中，这种差异大幅增加。

结论

在复发风险分析中考虑竞争事件的重要性尚未得到充分认识，因为我们调查的研究中只有 6% 采用了 Aalen-Johansen 分析。因此，大多数先前的文献都高估了复发的风险。对于涉及年轻人低度病变的研究来说，高估可以忽略不计；然而，对于高级病变的研究来说，高估可能是严重的。