BACKGROUND: Women have a higher prevalence of meningiomas, and meningiomas express estrogen and progesterone receptors, suggesting a hormonal influence on tumorigenesis. Obesity in men is associated with increased circulating estrogen via an increase in aromatase-expressing adipocytes. We hypothesized obese men were more likely to have meningiomas.
OBJECTIVE: To identify differences in men undergoing craniotomy for meningioma compared to controls in a national cohort, and to validate this in an institutional series.
METHODS: National data was collected from the National Surgical Quality Improvement Program (NSQIP) database from 2005–2020 using the CPT codes for craniotomy of meningioma, other tumors, and aneurysms. Standard statistical methods were used to assess the association of obesity with meningioma resection relative to craniotomies for other tumors or aneurysms, and with 30-day postoperative medical complications (pneumonia, unplanned reintubation, pulmonary embolism, progressive renal insufficiency, acute renal failure, UTI, CVA, cardiac arrest, MI, DVT, or sepsis). A retrospective review (2008 – 2021) was performed of male meningioma patients undergoing resection at our institution. Obese (BMI ≥ 30) patients were characterized and compared to nonobese patients.
RESULTS: In NSQIP, we identified 3,707 male patients undergoing craniotomy for meningioma, 21,316 for other tumors, and 867 for aneurysms. Using multivariate logistic regression, age (OR: 1.02 [95% CI: 1.01 – 1.03], p < 0.001), diabetes mellitus (OR: 1.30 [95% CI:1.01 – 1.67], p = 0.03), and increased weight classification across all levels were independently associated with craniotomy for meningioma (Overweight: OR 1.41 [95% CI: 1.28 – 1.56], p < 0.001; class I: OR 1.96 [95% CI: 1.76 – 2.18], p < 0.001; class II: OR 2.19 [95% CI: 1.91 – 2.51], p < 0.001; Class III: OR 2.62 [95% CI: 2.21 – 3.09], p < 0.001)). Four hundred three (10.9%) meningioma resections had postoperative complications. Class III obesity (OR 1.76 [95% CI: 1.12 – 2.77], p = 0.01), age (OR 1.02 [95% CI: 1.01 – 1.03], p < 0.001), and diabetes (OR 1.30 [95% CI: 1.01 – 1.67], p = 0.03) were associated with complications.
In our institutional cohort, 177 male meningioma patients with a median follow-up of 48 months were identified. Sixty-seven (37.9%) were obese, greater than the age-adjusted baseline prevalence of obesity for males in Illinois (30.1%) Mean age at resection was 55.7 ± 12.4 and 58.8 ± 14.3 years for obese and non-obese men respectively (p = 0.13). Within the obese group, meningioma locations were 58.2% skull base, 31.3% convexity, 6% falx, and 4% multiple. Tumors were WHO grade 1 (56.7%), 2 (40.3%), and 3 (3%). Obese men were more likely to have skull base meningiomas (OR 2.1 [95% CI: 1.13 – 3.93], p = 0.03).
CONCLUSION: Obesity rate is higher among male patients with meningiomas than the general population, and obese men are more likely to undergo craniotomies for resections of meningiomas than other tumors or aneurysms. Obese men with meningiomas are more likely to have skull base tumors, suggesting a hormonal influence on skull-base tumorigenesis.