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Journal of Neuro-Oncology
Article . 2024 . Peer-reviewed
License: CC BY
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The importance of considering competing risks in recurrence analysis of intracranial meningioma

Authors: Christian Mirian; Lasse Rehné Jensen; Tareq A. Juratli; Andrea Daniela Maier; Sverre H. Torp; Helen A. Shih; Ramin A. Morshed; +70 Authors

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

Abstract

Abstract 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.

Keywords

Medical Sciences, Mental and Social Health, Research, Neurosciences, 610, Competing risk, Risk Assessment, Neoplasm Recurrence, Neurology, Local, Recurrence, Neuro-oncology, Medical Specialties, Medicine and Health Sciences, Meningeal Neoplasms, Humans, Meningeal Neoplasms/pathology [MeSH] ; Recurrence ; Aged [MeSH] ; Risk Assessment [MeSH] ; Humans [MeSH] ; Neuro-oncology ; Retrospective Studies [MeSH] ; Neoplasm Recurrence, Local/pathology [MeSH] ; Competing risk ; Meningioma/pathology [MeSH] ; Research ; Meningioma ; Neoplasm Recurrence, Local/epidemiology [MeSH], Neoplasm Recurrence, Local, Meningioma, Competing risk; Meningioma; Neuro-oncology; Recurrence, Aged, Retrospective Studies

  • BIP!
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    selected citations
    These citations are derived from selected sources.
    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    3
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Average
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
3
Top 10%
Average
Average
Green
hybrid