Female gender and exogenous progesterone exposition as risk factors for spheno-orbital meningiomas
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CLINICAL STUDY
Female gender and exogenous progesterone exposition as risk factors for spheno‑orbital meningiomas Caroline Apra1,2 · Paul Roblot3,4 · Abdu Alkhayri5 · Caroline Le Guérinel5 · Marc Polivka6 · Dorian Chauvet5 Received: 4 April 2020 / Accepted: 25 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective The great heterogeneity of meningiomas is challenging and we need to distinguish relevant subgroups. Sphenoorbital osteomeningiomas (SOOM) constitute a clinically specific entity, with slow-growing benign osteo-meningiomatous tumors, which recur after surgery in one fourth of cases. Neurosurgical daily practice, supported by the literature, shows that the vast majority of patients with SOOM are women, and we explored whether their epidemiological and hormonal profiles suggest a progesterone influence. Methods We retrospectively documented all radiologically and histologically confirmed cases of SOOM operated in 2005– 2019 in our institution. We completed the clinical and hormone history by systematic telephone interviews. Results In the literature, SOOM occur significantly more often in women than other meningiomas (749/847, 86.4% versus 73.8%, p = 0.002). Among 175 cases, we included 124 patients, 93.5% were women, younger than men (51 ± 5 versus 63 ± 8, p = 0.02). Women’ meningiomas showed more progesterone receptors (96.4% versus 50%, p 30, 21%). These figures tend to be higher than the general female population in this region, respectively 23.9% and 10.1% (Khi2; p = 0.06 and p = 0.07) [9]. In the literature review, we found 83 publications between 2010 and 2019, among which 24 series of spheno-orbital meningiomas, and we excluded 7 series because they lacked some relevant data [10–16]. Two teams published their series twice in this period [6, 17–19] and we excluded the smaller one in each case. Thus, we identified 14 articles each reporting 13 to 130 patients, as detailed in Table 2 [6, 18, 20–31]. We pooled those cases with our patients to obtain a population of 847 patients with surgical spheno-orbital meningiomas. Among them, 749 were women. Statistical analysis showed that the proportion of women among patients with spheno-orbital meningiomas is significantly higher than in patients with meningiomas in general when this literature series is compared with the largest meningiomas series, that describes 81.475 female for 110.359 cases (86.4% versus 73.8%, Khi2, p = 0.002) [8]. Other risk factors, such as body mass index, radiation history or hormone intake, were not described in the other series.
Discussion Until now, spheno-orbital meningiomas had not been identified as a subgroup of meningiomas particularly prone to hormonal influence, which our study tends to suggest. Indeed, meningiomas develop more often in women than in men [8], but spheno-orbital meningiomas develop spectacularly more often in women, with 86.4% of patients being female in our literature review and 93.5% in our series. The fact that women were significantly younger than men at
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