The concept, intention, and evaluation of the term treatment-refractory meningioma.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Jensen Lasse Rehné, Maier Andrea Daniela, Juratli Tareq A, Goutagny Stéphane, Bertero Luca, Graillon Thomas, Brokinkel Benjamin, Gupta Tejpal, Torp Sverre Helge, Rudà Roberta, Clement Paul M, van Essen Martijn, Tabernero María Dolores, Gousias Konstantinos, Rodríguez Álvaro Otero, Chang Jong Hee, Suh Chang-Ok, Cardona Andrés Felipe, Arrieta Oscar, Ruiz-Patiño Alejandro, Bota Daniela A, Hrachova Maya, Scheie David, Kristensen Bjarne Winther, Munch Tina Nørgaard, Law Ian, Fugleholm Kåre, Meling Torstein Ragnar, Furtner Julia, Preusser Matthias, Walter Martin Alexander, Mathiesen Tiit, Mirian Christian
Аннотация
METHODS: We systematically reviewed 69 studies published before 2024 and analyzed individual participant data from 15 cohorts (n = 211) that included treatment-refractory patients who underwent experimental therapy with somatostatin receptor (SSTR)-targeted therapies. A reference cohort (n = 102) with newly diagnosed WHO-3 meningiomas was used descriptively for comparison. Progression and death were the primary endpoints. Hazard rate ratios were estimated via Poisson regression, and inter-study heterogeneity was quantified using I² statistics.
RESULTS: Definitions of treatment-refractory varied substantially across previous studies. WHO-1 patients showed high statistical inter-study variability, particularly for the long-acting SSTR-analogues group when assessing progression (I² = 81.7%) and death (I² =74.8%). Patients with treatment-refractory WHO-2 and WHO-3 meningioma exhibited more consistency across endpoints and SSTR-targeted therapies (I² percentages ≤ 16.0%). Risk of progression and death differed significantly by WHO grade, regardless of SSTR-targeted therapy.
CONCLUSIONS: Our findings demonstrate an inconsistent use of the term treatment-refractory and substantial variability of effect estimates dependeing on the individual cohorts. Pooling patients across WHO grades is unfeasible for assessing treatment effects. Based on the present study and prior evidence, we outline recommendations to improve consistency in future trial design and enable more meaningful comparisons across studies. The recommendations are grouped into four categories: radiographic evaluation, endpoints, clinical core elements, and molecular classification.