Variation in meningioma recurrence risk estimates across observational cohorts: the influence of calendar time, WHO classifications, geographical settings, and healthcare systems
Abstract
Abstract Purpose Recurrence risk estimates underpin meningioma research, including molecular classification and clinical trial benchmarking, yet are often based on retrospective or historical data. The aim of this study was to assess the variation of recurrence risk estimates across calendar periods, WHO classification editions, geographical settings, and healthcare systems.thetermine Methods We analyzed 4,111 patients with primary WHO-1/-2 meningiomas from 31 centers in 15 countries (1990–2019). Recurrence was defined according to local radiological assessment. The 5- and 10-year recurrence risks were estimated using regression standardization with inverse probability of censoring weights, adjusting for key clinical, surgical, and histopathological variables. Results Recurrence risk estimates varied across all domains examined. More recent calendar periods were associated with higher predicted recurrence risk, particularly for WHO-2 at 5 years (e.g., ≥ 2013 vs. ≤ 2007: RR 1.60, 95% CI 1.19–2.01). Differences were also observed across healthcare systems and geographical settings despite adjustment. In contrast, recurrence risk estimates were broadly comparable between WHO classification editions (2007 vs. 2016). Cohort-level visualization revealed substantial heterogeneity in follow-up duration, inclusion patterns, and recurrence detection. Conclusions Recurrence risk estimates are not stable across time or settings and are influenced by several patterns, particularly data accrual patterns. Recurrence events are inherently “locked” to the historical context in which they were detected, which may have important implications for developing molecular classifiers using retrospective specimens and clinical trials relying on benchmark established in historical settings. We propose transparent visualization of observational cohort composition and individual-level event timing to improve interpretability and comparability.
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Authors: Christian Mirian, Lasse Rehné Jensen, Adam Gorm Hoffmann, Tareq A. Juratli, Anders Broechner, Sverre H. Torp, Helen A. Shih, Ramin A. Morshed, Jacob S. Young, Stephen T. Magill, Luca Bertero, Walter Stummer, Dorothee Cäcilia Spille, Benjamin Brokinkel, Soichi Oya, Satoru Miyawaki, Nobuhito Saito, Martin Proescholdt, Yasuhiro Kuroi, Konstantinos Gousias, Matthias Simon, Jennifer Moliterno, Ricardo Prat-Acín, Stéphane Goutagny, Vikram C. Prabhu, John T. Tsiang, Johannes Wach, Erdem Güresir, Junkoh Yamamoto, Young Zoon Kim, Joo Ho Lee, Daniel W. Kim, Matthew Koshy, Karthikeyan Perumal, Mustafa K. Baskaya, Donald M. Cannon, Dennis C. Shrieve, Chang‐Ok Suh, Jong Hee Chang, Maria Kamenova, Sven Straumann, Jehuda Soleman, I.Y. Eyüpoglu, Tony Catalan, Austin Lui, Philip V. Theodosopoulos, Michael W. McDermott, Fang Wang, Pedro Góes, Manoel Antônio de Paiva Neto, Ricardo Komotar, Michael E. Ivan, Aria Jamshidi, Evan Luther, Luís Souhami, Marie-Christine Guiot, Tamás Csonka, Toshiki Endo, Olivia Claire Barrett, Randy Jensen, Tejpal Gupta, Akash J. Patel, Tiemo J. Klisch, Jun Won Kim, Francesco Maiuri, Valeria Barresi, María Dolores Tabernero, Simon Skyrman, Ian Law, Bjarne Winther Kristensen, Tina Nørgaard Munch, Torstein R. Meling, Kåre Fugleholm, Paul Blanche, Tiit Mathiesen, Andrea Daniela Maier
Institutions: Fondazione IRCCS Istituto Neurologico Carlo Besta, University of Verona, Tohoku Medical and Pharmaceutical University, Northwestern University, Hackensack Meridian Health, Karolinska Institutet, Harvard University, University Hospital of Basel, McGill University Health Centre, University of California, San Francisco, Yonsei University, Statens Serum Institut, University of Copenhagen, Rigshospitalet, Seoul National University Hospital, University of Utah, University Hospital Carl Gustav Carus, University of Illinois Chicago, Université Paris Cité, Hôpital Beaujon, Copenhagen University Hospital, University of Münster, University of Wisconsin–Madison, Assistance Publique – Hôpitaux de Paris, Universidade Federal de São Paulo, Sungkyunkwan University, Saitama Medical University, University of Debrecen, Massachusetts General Hospital, University Hospital Leipzig, Seoul National University, University of Naples Federico II, Loyola University Medical Center, University Hospital Regensburg, Baylor College of Medicine, Gangnam Severance Hospital, University of Tokyo Hospital, Samsung (South Korea), First Affiliated Hospital of Zhengzhou University, Neurological Surgery, Norwegian University of Science and Technology, St Olav's University Hospital, Leitat Technological Center, Instituto de Investigación Biomédica de Salamanca, Huntsman Cancer Institute, University of Occupational and Environmental Health Japan, Department of Medical Sciences, Tata Memorial Hospital, Sylvester Comprehensive Cancer Center, Yale New Haven Hospital, Social Insurance Saitama Chuo Hospital, Clemenshospital Münster, Tokyo Women's Medical University Adachi Medical Center, Athens Medical Center, Smilow Cancer Hospital, University of Illinois Hospital & Health Sciences System, Allegheny General Hospital, Mobile Infirmary, Advanced Centre for Treatment, Research and Education in Cancer, Neurological Research Institute