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Pichardo-Rojas PS, Dono A, Ballester LY, Esquenazi Y. Novel Postoperative Serum Biomarkers in Atypical Meningiomas: A Multicenter Study. Neurosurgery 2023; 93:599-610. [PMID: 36921247 PMCID: PMC10827320 DOI: 10.1227/neu.0000000000002457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/18/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND There has been no known serum biomarker to predict the prognosis of atypical meningioma. OBJECTIVE To investigate the prognostic impact of serum biomarkers in patients newly diagnosed with resected intracranial atypical meningiomas. METHODS This study enrolled 523 patients with atypical meningioma who underwent surgical resection between 1998 and 2018 from 5 Asian institutions. Serum laboratory data within 1 week after surgery were obtained for analysis. Optimal cutoffs were calculated for each serum marker using the maxstat package of R. RESULTS Of 523 patients, 19.5% underwent subtotal resection and 29.8% were treated with adjuvant radiation therapy (ART). Among the 523 patients, 454 were included in the multivariate analysis for the progression/recurrence (P/R) rate excluding patients with incomplete histopathologic or laboratory data. On multivariate analysis, tumor size >5 cm, subtotal resection, and postoperative aspartate aminotransferase/alanine transaminase (De Ritis) ratio >2 were associated with higher P/R rates, whereas ART and postoperative platelet count >137 × 10 3 /μL were associated with lower P/R rates. In the subgroup of patients treated with ART, tumor size >5 cm and postoperative neutrophil-to-lymphocyte ratio >21 were associated with higher P/R rates. By contrast, postoperative De Ritis ratio >2 remained an adverse prognosticator in patients not treated with ART. CONCLUSION Postoperative De Ritis ratio, platelet count, and neutrophil-to-lymphocyte ratio were revealed as a novel serum prognosticator in newly diagnosed atypical meningiomas. Additional studies are warranted to validate its clinical significance and biological background.
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Affiliation(s)
- Pavel S. Pichardo-Rojas
- Vivian L. Smith Department of Neurosurgery, McGovern
Medical School, the University of Texas Health Science Center at Houston, TX
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, McGovern
Medical School, the University of Texas Health Science Center at Houston, TX
| | - Leomar Y. Ballester
- Department of Pathology, The University of Texas MD
Anderson Cancer Center, Houston, Texas 77030, USA
- Department of Translational Molecular Pathology, The
University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern
Medical School, the University of Texas Health Science Center at Houston, TX
- Memorial Hermann Hospital-TMC, Houston, TX
- Center for Precision Health, School of Biomedical
Informatics, McGovern Medical School, the University of Texas Health Science Center
at Houston, TX
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2
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Tang AR, Chotai S, Guidry BS, Sun L, Ye F, Kelly PD, McDermott JR, Grisham CJ, Morone PJ, Thompson RC, Chambless LB. Conditional Recurrence-Free Survival After Surgical Resection of Meningioma. Neurosurgery 2023; 93:339-347. [PMID: 36815800 DOI: 10.1227/neu.0000000000002416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Recurrence after meningioma resection warrants serial surveillance imaging, but little evidence guides the optimal time interval between imaging studies/surveillance duration. OBJECTIVE To describe recurrence-free survival (RFS) after meningioma resection, conditioned to short-term RFS. METHODS A retrospective cohort study for adults presenting for meningioma resection from 2000 to 2018 was conducted. The primary outcome was postoperative follow-up RFS. Conditional RFS Kaplan-Meier analysis was performed at 1, 2, 3, 5, and 10 years, conditioned to 6-month and 12-month RFS. RFS probabilities conditioned to 6-month RFS were estimated in subgroups, stratified by World Health Organization grade, extent of resection, and need for postoperative radiation. RESULTS In total, 723 patients were included. Median age at surgery was 57.4 years (IQR = 47.2-67.2). Median follow-up was 23.5 months (IQR = 12.3-47.8). Recurrence was observed in 90 patients (12%), with median time to recurrence of 14.4 months (IQR = 10.3-37.1). Conditioned to 6-month postoperative RFS, patients had 90.3% probability of remaining recurrence-free at 2 years and 69.4% at 10 years. Subgroup analysis conditioned to 6-month RFS demonstrated grade 1 meningiomas undergoing gross total resection (GTR) had 96.0% probability of RFS at 1 year and 82.8% at 5 years, whereas those undergoing non-GTR had 94.5% and 79.9% probability, respectively. RFS probability was 78.8% at 5 years for non-grade 1 meningiomas undergoing GTR, compared with 69.7% for non-grade 1 meningiomas undergoing non-GTR. Patients with non-grade 1 meningiomas undergoing upfront radiation had a 1-year RFS of 90.1% and 5-year RFS of 51.7%. CONCLUSION Recurrence risk after meningioma resection after an initial recurrence-free period is reported, with high-risk subgroups identified. These results can inform objective shared decision-making for optimal follow-up.
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Affiliation(s)
- Alan R Tang
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Silky Chotai
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bradley S Guidry
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lili Sun
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Peter J Morone
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Khan MA, Khan H, Saeed B, Khan IU. Case of a WHO Grade II Atypical Meningioma in a 16-Year-Old Female. Cureus 2023; 15:e37752. [PMID: 37213945 PMCID: PMC10193516 DOI: 10.7759/cureus.37752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Meningiomas have a high frequency of occurrence as primary intracranial tumors. We report the case of a 16-year-old female who presented with a three-week history of persistent headache, vomiting, and photophobia. Imaging studies revealed the presence of a meningioma in the right occipital lobe of the brain. The patient underwent surgical resection, and histopathological analysis confirmed the diagnosis of an atypical WHO grade 2 meningioma. The patient experienced a significant improvement in her symptoms postoperatively and had no evidence of recurrence on follow-up imaging. This case highlights the importance of considering meningioma in the differential diagnosis of relatively young patients presenting with chronic headaches, and the favorable prognosis associated with atypical WHO grade 2 meningiomas following complete surgical resection.
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Affiliation(s)
- Mahad A Khan
- Medicine and Surgery, Islamabad Medical and Dental College, Islamabad, PAK
| | - Haysum Khan
- Medicine and Surgery, Shifa Tameer-e-Millat University Shifa College of Medicine, Islamabad, PAK
| | - Bazeela Saeed
- Neurology, Shifa International Hospital, Islamabad, PAK
| | - Inayat U Khan
- Neurological Surgery, Kulsum International Hospital, Islamabad, PAK
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Byun HK, Chang WI, Lee JH, Park CK, Kim IA, Kim CY, Cho J, Kim EH, Chang JH, Kang SG, Moon JH, Lee SH, Lee JJB, Kim IH, Suh CO, Wee CW, Yoon HI. Adjuvant Radiotherapy Versus Surveillance for Grade 2 Intracranial Meningiomas: A Multi-Institutional Propensity Score-Matched Study. Front Oncol 2022; 12:877244. [PMID: 35847889 PMCID: PMC9283569 DOI: 10.3389/fonc.2022.877244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose We aimed to compare the outcomes of adjuvant radiotherapy (ART) and surveillance in patients with grade 2 meningiomas (MNG2) who underwent surgical resection. Materials and Methods Data from four hospitals, in which patients aged ≥18 years underwent Simpson grade 1−4 surgical resection for newly diagnosed MNG2 between 1998 and 2018, were examined in this multicenter retrospective cohort study. Patients receiving ART with conventional fractionation were compared with those undergoing surveillance. Progression-free survival (PFS), progression/recurrence (P/R) were evaluated. Results This study included 518 patients, 158 of whom received ART. The median follow-up duration was 64.9 months. In the total cohort, ART was independently associated with significantly improved PFS (HR, 0.35; 95% CI, 0.23–0.55; P<0.001) and P/R (HR, 0.30; 95% CI, 0.18–0.48; P<0.001). In the propensity score-matched cohort (n=143 in each group), the 5-year PFS rates were 80.8% and 57.7% (P=0.004), and the 5-year P/R rates were 16.5% and 40.0% (P=0.002) in the ART and surveillance groups, respectively. After gross total resection, the 5-year PFS (85.0% vs. 64.7%; P=0.020) and P/R rates (15.2% vs. 32.0%; P=0.035) were significantly better in the ART group than in the surveillance group. A model for P/R was developed using recursive partitioning analysis with surgical extent, tumor size, and Ki-67 index. ART reduced the risk of P/R in the low- (P=0.069), intermediate- (P=0.044), and high-risk groups (P<0.001). Local control was also significantly enhanced by ART among all the risk groups (all P<0.05). Conclusions ART significantly improved PFS and P/R in patients with MNG2, irrespective of the surgical extent, and can be recommended after gross total resection. A prognostic model may guide decision-making for the use of ART.
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Affiliation(s)
- Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Ick Chang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Hyung Lee
- Department of Neurosurgery, Seoul Metropolitan Government - Seoul National University (SMG-SNU) Boramae Medical Center, Seoul, South Korea
| | - Jason Joon Bock Lee
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Bundang CHA Medical Center, CHA University, Seongnam, South Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul Metropolitan Government - Seoul National University (SMG-SNU) Boramae Medical Center, Seoul, South Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Chan Woo Wee, ; Hong In Yoon,
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Chan Woo Wee, ; Hong In Yoon,
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Abstract
Meningioma is the most common primary neoplasm of the central nervous system (CNS). Generally, these tumors are benign and have a good prognosis. However, treatment can be challenging in cases with aggressive variants and poor prognoses. Among various prognostic factors that have been clinically investigated, bone invasion remains controversial owing to a limited number of assessments. Recent study reported that bone invasion was not associated with WHO grades, progression, or recurrence. Whereas, patients with longer-recurrence tended to have a higher incidence of bone invasion. Furthermore, bone invasion may be a primary preoperative predictor of the extent of surgical resection. Increasing such evidence highlights the potential of translational studies to understand bone invasion as a prognostic factor of meningiomas. Therefore, this mini-review summarizes recent advances in pathophysiology and diagnostic modalities and discusses future research directions and therapeutic strategies for meningiomas with bone invasion.
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Affiliation(s)
- Hajime Takase
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- *Correspondence: Hajime Takase, ; orcid.org/0000-0001-5813-1386
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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6
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Yu ZY, Chung MH, Wang PW, Wu YC, Liao HC, Hueng DY. Letter to the Editor. Outcome of malignant meningioma. J Neurosurg 2022; 137:1. [PMID: 35623366 DOI: 10.3171/2022.3.jns22645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zong-Yu Yu
- 1Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Hsuan Chung
- 1Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Peng-Wei Wang
- 1Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Chieh Wu
- 1Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsiang-Chih Liao
- 1Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dueng-Yuan Hueng
- 1Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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7
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Kent CL, Mowery YM, Babatunde O, Wright AO, Barak I, McSherry F, Herndon JE, Friedman AH, Zomorodi A, Peters K, Desjardins A, Friedman H, Sperduto W, Kirkpatrick JP. Long-Term Outcomes for Patients With Atypical or Malignant Meningiomas Treated With or Without Radiation Therapy: A 25-Year Retrospective Analysis of a Single-Institution Experience. Adv Radiat Oncol 2022; 7:100878. [PMID: 35647401 PMCID: PMC9133398 DOI: 10.1016/j.adro.2021.100878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/06/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose Atypical (World Health Organization [WHO] grade 2) and malignant (WHO grade 3) meningiomas have high rates of local recurrence, and questions remain about the role of adjuvant radiation therapy (RT) for patients with WHO grade 2 disease. These patients frequently require salvage therapy, and optimal management is uncertain given limited prospective data. We report on the long-term outcomes for patients with atypical and malignant meningiomas treated with surgery and/or RT at our institution. Methods and Materials Data were collected through a retrospective chart review for all patients with WHO grade 2 or 3 meningiomas treated with surgery and/or RT at our institution between January 1992 and March 2017. Progression-free survival (PFS) and overall survival (OS) were described using the KaplanMeier estimator. The outcomes in the subgroups were compared with a log-rank test. A Cox proportional hazards model was used for the univariable and multivariable analyses of predictors of PFS. Results A total of 66 patients were included in this analysis. The median follow-up was 12.4 years overall and 8.6 years among surviving patients. Fifty-two patients (78.8%) had WHO grade 2 meningiomas, and 14 patients (21.2%) had WHO grade 3 disease. Thirty-six patients (54.5%) were treated with surgery alone, 28 patients (42.4%) with surgery and adjuvant RT, and 2 patients (3%) with RT alone. Median PFS and OS were 3.2 years and 8.8 years, respectively. PFS was significantly improved with adjuvant RT compared with surgery alone (hazard ratio, 0.36; 95% confidence interval, 0.18-0.70). Patients with Ki-67 index >10% showed a trend toward worse PFS compared with patients with Ki-67 ≤10% (hazard ratio, 0.51; 95% confidence interval, 0.25-1.04). No significant differences in PFS or OS were observed with respect to Simpson or WHO grade. Conclusions For patients with atypical or malignant meningiomas, adjuvant RT was associated with significantly improved PFS, and Ki-67 index >10% was associated with a trend toward worse PFS. Given the long-term survival, high recurrence rates, and efficacy of salvage therapy, patients with atypical and malignant meningiomas should be monitored systematically long after initial treatment.
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Affiliation(s)
- Collin L. Kent
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Yvonne M. Mowery
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Olayode Babatunde
- Department of Internal Medicine, Columbia University, New York, New York
| | - Ato O. Wright
- Department of Radiation Oncology, University of Pittsburgh Medical Center (UPMC) Pinnacle, Carlisle, Pennsylvania
| | - Ian Barak
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Frances McSherry
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - James E. Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Allan H. Friedman
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
| | - Katherine Peters
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
| | - Annick Desjardins
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
| | - Henry Friedman
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
| | | | - John P. Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
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8
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Picart T, Dumot C, Guyotat J, Pavlov V, Streichenberger N, Vasiljevic A, Fenouil T, Durand A, Jouanneau E, Ducray F, Jacquesson T, Berhouma M, Meyronet D. Clinical and pathological impact of an optimal assessment of brain invasion for grade 2 meningioma diagnosis: lessons from a series of 291 cases. Neurosurg Rev 2022; 45:2797-2809. [PMID: 35488071 DOI: 10.1007/s10143-022-01792-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
Brain invasion has not been recognized as a standalone criterion for atypical meningioma by the WHO classification until 2016. Since the 2007 edition suggested that meningiomas harboring brain invasion could be classified as grade 2, brain invasion study was progressively strengthened in our center, based on a strong collaboration between neurosurgeons and neuropathologists regarding sample orientation and examination. Practice changes were considered homogeneous enough in 2011. The aim of the present study was to evaluate the impact of gross practice change on the clinical and pathological characteristics of intracranial meningiomas classified as grade 2.The characteristics of consecutive patients with a grade 2 meningioma surgically managed before (1998-2005, n = 125, group A) and after (2011-2014, n = 166, group B) practices changed were retrospectively reviewed.Sociodemographical and clinical parameters were comparable in groups A and B, and the median age was 62 years in both groups (p = 0.18). The 5-year recurrence rates (23.2% vs 29.5%, p = 0.23) were similar. In group A, brain invasion was present in 48/125 (38.4%) cases and was more frequent than in group B (14/166, 8.4%, p < 0.001). In group A, 33 (26.4%) meningiomas were classified as grade 2 solely based on brain invasion (group ASBI), and 92 harbored other grade 2 criteria (group AOCA). Group ASBI meningiomas had a similar median progression-free survival compared to groups AOCA (68 vs 80 months, p = 0.24) and to AOCA and B pooled together (n = 258, 68 vs 90 months, p = 0.42).An accurate assessment of brain invasion is mandatory as brain invasion is a strong predictor of meningioma progression.
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Affiliation(s)
- Thiébaud Picart
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France. .,Claude Bernard University, Lyon 1, Lyon, France. .,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.
| | - Chloé Dumot
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CarMeN Laboratory, Inserm U1060, INRA U1397, INSA Lyon, Université Claude Bernard, Lyon 1, Lyon, France
| | - Jacques Guyotat
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France
| | - Vladislav Pavlov
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France
| | - Nathalie Streichenberger
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France.,CNRS UMR 5310 - INSERM U1217, Institut NeuroMyogène, Lyon, France
| | - Alexandre Vasiljevic
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Tanguy Fenouil
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Anne Durand
- Department of Neurosurgery, Medipole Lyon Villeurbanne MHP, Villeurbanne, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CNRS UMR5286, Inserm U1052, Cancer Research Center of Lyon, Lyon, France
| | - François Ducray
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Neurooncology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Timothée Jacquesson
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,Laboratory of Anatomy, Faculty of Medicine Lyon Est, University Claude Bernard Lyon 1, Lyon, France
| | - Moncef Berhouma
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.,Claude Bernard University, Lyon 1, Lyon, France.,CREATIS Laboratory, Inserm U1206, UMR 5220, Université de Lyon, Villeurbanne, France
| | - David Meyronet
- Claude Bernard University, Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity - INSERM U1052, Cancer Research Center of Lyon, Lyon, France.,Department of Neuropathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
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9
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Huang W, Shu X, Wang Z, Zhang L, Chen C, Xu J, Yi Z. Feature Pyramid Network With Level-Aware Attention for Meningioma Segmentation. IEEE Trans Emerg Top Comput Intell 2022. [DOI: 10.1109/tetci.2022.3146965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Kwon SM, Kim JH, Kim YH, Hong SH, Cho YH, Kim CJ, Nam SJ. Clinical Implications of the Mitotic Index as a Predictive Factor for Malignant Transformation of Atypical Meningiomas. J Korean Neurosurg Soc 2021; 65:297-306. [PMID: 34879641 PMCID: PMC8918253 DOI: 10.3340/jkns.2021.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/23/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Intracranial atypical meningiomas have a poor prognosis and high rates of recurrence. Moreover, up to one-third of the recurrences undergo high-grade transformation into malignant meningiomas. We aimed to investigate the clinical factors that can predict the propensity of malignant transformation from atypical to anaplastic meningiomas. Methods Between 2001 and 2018, all patients with atypical meningioma, in whom the tumors had undergone malignant transformation to anaplastic meningioma, were included. The patients' medical records documenting the diagnosis of atypical meningioma prior to malignant transformation were reviewed to identify the predictors of transformation. The control group comprised 56 patients with atypical meningiomas who were first diagnosed between January 2017 and December 2018 and had no malignant transformation. Results Nine patients in whom the atypical meningiomas underwent malignant transformation were included. The median time interval from diagnosis of atypical meningioma to malignant transformation was 19 months (range, 7-78). The study group showed a significant difference in heterogeneous enhancement (77.8% vs. 33.9%), bone invasion (55.6% vs. 12.5%), mitotic index (MI; 14.8±4.9 vs. 3.5±3.9), and Ki-67 index (20.7±13.9 vs. 9.5±7.1) compared with the control group. In multivariate analysis, increased MI (odds ratio, 1.436; 95% confidence interval, 1.127-1.900; p=0.004) was the only significant factor for predicting malignant transformation. Conclusion An increased MI within atypical meningiomas might be used as a predictor of malignant transformation. Tumors at high risk for malignant transformation might require more attentive surveillance and management than other atypical meningiomas.
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Affiliation(s)
- Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Jin Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Jeong Nam
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Abstract
Patient: Female, 58-year-old Final Diagnosis: Meningioma Symptoms: Abdominal pain • bleeding • headache Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Aisha Mohammed Alshibany
- Department of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hamed Homoud Al-Husaini
- Department of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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12
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Abstract
INTRODUCTION There are a number of prognostic markers (methylation, CDKN2A/B) described to be useful for the stratification of meningiomas. However, there are currently no clinically validated biomarkers for the preoperative prediction of meningioma grade, which is determined by the histological analysis of tissue obtained from surgery. Accurate preoperative biomarkers would inform the pre-surgical assessment of these tumours, their grade and prognosis and refine the decision-making process for treatment. This review is focused on the more controversial grade II tumours, where debate still surrounds the need for adjuvant therapy, repeat surgery and frequency of follow up. METHODS We evaluated current literature for potential grade II meningioma clinical biomarkers, focusing on radiological, biochemical (blood assays) and immunohistochemical markers for diagnosis and prognosis, and how they can be used to differentiate them from grade I meningiomas using the post-2016 WHO classification. To do this, we conducted a PUBMED, SCOPUS, OVID SP, SciELO, and INFORMA search using the keywords; 'biomarker', 'diagnosis', 'atypical', 'meningioma', 'prognosis', 'grade I', 'grade 1', 'grade II' and 'grade 2'. RESULTS We identified 1779 papers, 20 of which were eligible for systematic review according to the defined inclusion and exclusion criteria. From the review, we identified radiological characteristics (irregular tumour shape, tumour growth rate faster than 3cm3/year, high peri-tumoural blood flow), blood markers (low serum TIMP1/2, high serum HER2, high plasma Fibulin-2) and histological markers (low H3K27me3, low SMARCE1, low AKAP12, high ARIDB4) that may aid in differentiating grade II from grade I meningiomas. CONCLUSION Being able to predict meningioma grade at presentation using the radiological and blood markers described may influence management as the likely grade II tumours will be followed up or treated more aggressively, while the histological markers may prognosticate progression or post-treatment recurrence. This to an extent offers a more personalised treatment approach for patients.
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Affiliation(s)
- Agbolahan A Sofela
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, Plymouth, UK.,South West Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Lucy McGavin
- Department of Radiology, Derriford Hospital, Plymouth, UK
| | - Peter C Whitfield
- South West Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - C Oliver Hanemann
- Faculty of Health: Medicine, Dentistry and Human Sciences, The Institute of Translational and Stratified Medicine, University of Plymouth, Plymouth, UK
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13
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Salles D, Santino SF, Malinverni ACM, Stávale JN. Meningiomas: A review of general, histopathological, clinical and molecular characteristics. Pathol Res Pract 2021; 223:153476. [PMID: 33991850 DOI: 10.1016/j.prp.2021.153476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this review, the main histological and molecular characteristics of meningiomas will be addressed, as well as the aspects most related to clinical conditions, treatment, and survival of patients, enabling a better understanding of these tumors behavior. METHODS This study was conducted with the search for published studies available on NCBI, PubMed, MEDLINE, Scielo and Google Scholar. Relevant documents have been identified and 50 articles were selected. RESULTS The main points about meningiomas were characterized, as well as the histological presence of spontaneous necrosis in grade I and brain invasion as diagnostic criteria, their molecular origin related to deletion of chromosome 22 and mutations in theNF2 and TERT genes, in addition to their clinical characteristics. The preferential treatment remains the total resection of the tumor. CONCLUSION The information about meningiomas is well known and necessary, but it is expected that more work will emerge related to the behavior of these tumors, and that the scientific community will obtain more clarity about the best ways to conduct the patients treatment.
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14
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Unteroberdörster M, Michel A, Darkwah Oppong M, Jabbarli R, Hindy NE, Wrede KH, Sure U, Pierscianek D. The 2016 Edition of the WHO Classification of Primary Brain Tumors: Applicable to Assess Individual Risk of Recurrence in Atypical Meningioma? A Single-Center Experience. J Neurol Surg A Cent Eur Neurosurg 2021; 82:417-423. [PMID: 33845510 DOI: 10.1055/s-0040-1720987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND STUDY AIMS/OBJECT Despite the relevance of molecular criteria for brain tumor diagnosis and prognosis, meningioma grading is still solely based on histologic features. Atypical meningiomas (AMs; WHO grade II) display a great histologic heterogeneity and individual courses of disease can differ significantly. This study aimed to identify clinically aggressive AMs that are prone to early recurrence after gross total resection (GTR) by assessing a specific histologic score. PATIENTS AND METHODS A retrospective analysis of 28 consecutive patients (17 females and 11 males; mean age of 62 years [range: 35-88 years]) treated in our institution between January 2006 and December 2015 was performed. Basic demographic and clinical characteristics were assessed. A scoring scale was designed to address the histologic diversity by summing up the individual histologic features in every tumor sample. According to that, points were awarded as follows: major AM defining criterion (3 points) and minor criterion (1 point). RESULTS The subclassification based on our specific histologic score revealed no significant difference in frequency of one (46.4%) or two (42.9%) AM defining features; three criteria were less frequently seen (10.7%). Mean follow-up was 61.89 ± 9.03 months. Local recurrence occurred in 35.7% after a mean time of 37.4 ± 22.6 months after primary surgery. Age > 60 years was significantly associated with a shorter progression-free survival (PFS). There was a trend toward shorter PFS with increasing scores, tantamount with the presence of several AM defining histologic criteria in one sample. No tumor relapse was seen when diagnosis was based only on minor criteria. CONCLUSION AMs display a histologic diversity. There is a trend toward shorter PFS with increasing numbers of AM defining histologic features. The inclusion of this score in the decision algorithm regarding further treatment for patients >60 years after GTR might be helpful and should be evaluated in further studies.
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Affiliation(s)
- Meike Unteroberdörster
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany.,Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Michel
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
| | | | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany.,Werne Spine Center, Hospital Lünen/Werne GmbH - St. Christophorus Hospital, Werne, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
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15
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Chun SW, Kim KM, Kim MS, Kang H, Dho YS, Seo Y, Kim JW, Kim YH, Park CK. Adjuvant radiotherapy versus observation following gross total resection for atypical meningioma: a systematic review and meta-analysis. Radiat Oncol 2021; 16:34. [PMID: 33596974 PMCID: PMC7890913 DOI: 10.1186/s13014-021-01759-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background The impact of adjuvant radiotherapy (RT) on atypical meningioma (AM) underwent a gross total resection (GTR) remains unclear, showing conflicting results from various studies. The objective of this study was to perform an updated meta-analysis for observational studies to determine the effect of adjuvant RT after GTR on local recurrence and survival outcomes compared to observation after GTR. Methods PubMed, Embase, and Web of Science were searched to identify comparative studies that reported outcomes of adjuvant RT versus observation for AM patients after GTR. Local recurrence rate, progression-free survival (PFS), overall survival (OS), and toxicities related to RT were considered as outcomes of interest. Differences between two cohorts were estimated by calculating odds ratios (OR) for LR rate and hazard ratios (HR) for survival outcomes with 95% confidence intervals (CIs) for meta-analysis, using R version 4.0.3 software. Included studies were appraised with the Risk of Bias Assessment tool for Non-Randomized Studies. Outcome ratios were combined with the Mantel–Haenszel method and the inverse variance-weighted method, appropriately. Results Data from 30 studies involving 2904 patients (adjuvant RT: n = 737; observation: n = 2167) were eventually included. Significant reduction of local recurrence rate was seen in the adjuvant RT cohort compare to that in the observation cohort (OR 0.50; 95% CI 0.36–0.68; p < 0.0001). Pooled HRs of PFS at 1-year, 3-year, 5-year, and > 5-year revealed that adjuvant RT was superior to observation. There was no significant difference in OS between the two cohorts during any period. Most toxicities were tolerable with grade 1 or 2. There was no documented grade 5 toxicity. Conclusions For AM patients who underwent GTR, evidence suggested that adjuvant RT could potentially decrease local recurrence and improve PFS better than observation.
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Affiliation(s)
- Se-Woong Chun
- Department of Rehabilitation Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Kyung Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Min-Sung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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16
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Prat-Acín R, Guarín-Corredor MJ, Galeano-Senabre I, Ayuso-Sacido A, Vera-Sempere F. Value of KI-67/MIB-1 labeling index and simpson grading system to predict the recurrence of who grade I intracranial meningiomas compared to who grade II. J Clin Neurosci 2021; 86:32-37. [PMID: 33775343 DOI: 10.1016/j.jocn.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 12/21/2022]
Abstract
Simpson grading of resection has been used as a predictor of intracranial meningioma (IM) recurrence. Histopathological findings, like the Ki-67/MIB-1 labeling index, may be useful in the assessment risk of recurrence. Our objective was to analyze the predictive value of meningioma recurrence using both parameters. We retrospectively studied 322 consecutive patients with histopathological diagnosis of IM WHO grade I and 43 patients with IM WHO grade II in a 13-year period. Multivariate survival analysis was performed. In the WHO grade I IM group, recurrence was observed in 28 patients (8.69%). The Cox regression model for WHO grade I IM, provided a significative hazard ratio (HR) for Ki-67/MIB-1 index ≥3 (HR = 36.35, p < 0.001) and Simpson's grading resection, grade II (HR = 2.03, p = 0.045), grade III (HR = 3.41, p = 0.034) and grade IV (HR = 19.75, p ≥ 0.001). In the WHO grade II IM group, recurrence was observed in 10 patients (23.25%). The Cox regression model for WHO grade II IM, provided a significative hazard ratio (HR) for Ki-67/MIB-1 index ≥3% (HR = 1.66, p < 0.001) and Simpson's grading resection grade III (HR = 3.96, p = 0.027). The Kaplan-Meier survival curve showed a similar distribution of survival between WHO grade I IM with Ki-67/MIB-1 ≥3% and WHO grade II IM. In WHO grade I meningiomas, the Ki-67/MIB-1 index and Simpson grading were both independent predictors of recurrence. A similar management protocol should be advisable for WHO grade I with Ki-67/MIB-1 ≥3% and WHO grade II meningiomas.
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Affiliation(s)
- Ricardo Prat-Acín
- Neurosurgery Department. Hospital Universitario y Politécnico La Fe, Valencia, Spain; Nanomedicine and Sensors Unit, Hospital Universitario y Politécnico La Fe, Universidad Politécnica de Valencia, Spain.
| | | | - Inma Galeano-Senabre
- Neurosurgery Department. Hospital Universitario y Politécnico La Fe, Valencia, Spain; Nanomedicine and Sensors Unit, Hospital Universitario y Politécnico La Fe, Universidad Politécnica de Valencia, Spain
| | - Angel Ayuso-Sacido
- Brain Tumour Laboratory, Fundación Vithas, Grupo Hospitales Vithas, Madrid, Spain; Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
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17
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Sofela AA, Hilton DA, Ammoun S, Baiz D, Adams CL, Ercolano E, Jenkinson MD, Kurian KM, Teo M, Whitfield PC, Sahm F, Hanemann CO. Fibulin-2: A Novel Biomarker for Differentiating Grade II from Grade I Meningiomas. Int J Mol Sci 2021; 22:E560. [PMID: 33429944 DOI: 10.3390/ijms22020560] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/21/2022] Open
Abstract
There is an unmet need for the identification of biomarkers to aid in the diagnosis, clinical management, prognosis and follow-up of meningiomas. There is currently no consensus on the optimum management of WHO grade II meningiomas. In this study, we identified the calcium binding extracellular matrix glycoprotein, Fibulin-2, via mass-spectrometry-based proteomics, assessed its expression in grade I and II meningiomas and explored its potential as a grade II biomarker. A total of 87 grade I and 91 grade II different meningioma cells, tissue and plasma samples were used for the various experimental techniques employed to assess Fibulin-2 expression. The tumours were reviewed and classified according to the 2016 edition of the Classification of the Tumours of the central nervous system (CNS). Mass spectrometry proteomic analysis identified Fibulin-2 as a differentially expressed protein between grade I and II meningioma cell cultures. Fibulin-2 levels were further evaluated in meningioma cells using Western blotting and Real-time Quantitative Polymerase Chain Reaction (RT-qPCR); in meningioma tissues via immunohistochemistry and RT-qPCR; and in plasma via Enzyme-Linked Immunosorbent Assay (ELISA). Proteomic analyses (p < 0.05), Western blotting (p < 0.05) and RT-qPCR (p < 0.01) confirmed significantly higher Fibulin-2 (FBLN2) expression levels in grade II meningiomas compared to grade I. Fibulin-2 blood plasma levels were also significantly higher in grade II meningioma patients compared to grade I patients. This study suggests that elevated Fibulin-2 might be a novel grade II meningioma biomarker, when differentiating them from the grade I tumours. The trend of Fibulin-2 expression observed in plasma may serve as a useful non-invasive biomarker.
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18
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Nakasu S, Nakasu Y. Prognostic significance of brain invasion in meningiomas: systematic review and meta-analysis. Brain Tumor Pathol 2021; 38:81-95. [PMID: 33403457 DOI: 10.1007/s10014-020-00390-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022]
Abstract
The WHO 2016 classification introduced brain invasion as a standalone criterion for grade II meningioma (GIIM). We systematically reviewed studies published after 2000 and performed a PRISMA-compliant meta-analysis of the hazard ratios (HRs) for progression-free survival (PFS) between brain-invasive and noninvasive meningiomas. In five studies that included both benign and higher-grade meningiomas, brain invasion was a significant risk factor for recurrence (HR = 2.45, p = 0.0004). However, in 3 studies comparing "brain-invasive meningioma with otherwise benign histology (BIOB)" with grade I meningioma, brain invasion was not a significant predictor of PFS (HR = 1.49, p = 0.23). Among GIIM per the WHO 2000 criteria, brain invasion was a significant predictor of shorter PFS than noninvasive GIIM (HR = 3.40, p = 0.001) but not per the WHO 2016 criteria (HR 1.13, p = 0.54), as the latter includes BIOB. Meta-regression analysis of seven studies of grade II meningioma showed that more frequent BIOB was associated with lower HRs (p < 0.0001). Hence, there is no rationale for brain invasion as a standalone criterion for grade II meningioma, although almost all studies were retrospective and exhibited highly heterogeneous HRs due to differences in brain-tumor interface data availability.
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19
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Tian W, Liu J, Zhao K, Wang J, Jiang W, Shu K, Lei T. Analysis of Prognostic Factors of World Health Organization Grade Ⅲ Meningiomas. Front Oncol 2020; 10:593073. [PMID: 33425743 PMCID: PMC7793968 DOI: 10.3389/fonc.2020.593073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Objective WHO grade III meningiomas are highly aggressive and lethal. However, there is a paucity of clinical information because of a low incidence rate, and little is known for prognostic factors. The aim of this work is to analyze clinical characteristics and prognosis in patients diagnosed as WHO grade III meningiomas. Methods 36 patients with WHO grade III meningiomas were enrolled in this study. Data on gender, age, clinical presentation, preoperative Karnofsky Performance Status (KPS), histopathologic features, tumor size, location, radiologic findings, postoperative radiotherapy (RT), surgical treatment, and prognosis were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method. Univariate and multivariate analysis were conducted by the Cox regression model. Results Median PFS is 20 months and median OS is 36 months in 36 patients with WHO grade III meningiomas. Patients with secondary tumors which transformed from low grade meningomas had lower PFS (p=0.0014) compared with primary group. Multivariate analysis revealed that tumors location (PFS, p=0.016; OS, p=0.013), Ki-67 index (PFS, p=0.004; OS, p<0.001) and postoperative radiotherapy (PFS, p=0.006; OS, p<0.001) were associated with prognosis. Conclusion WHO grade III meningiomas which progressed from low grade meningiomas were more prone to have recurrences or progression. Tumors location and Ki-67 index can be employed to predict patient outcomes. Adjuvant radiotherapy after surgery can significantly improve patient prognosis.
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Affiliation(s)
- Weidong Tian
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Jingdian Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Jiang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Wang D, Sun S, Hua L, Deng J, Luan S, Cheng H, Xie Q, Wakimoto H, Zhu H, Gong Y. Prognostic Model That Predicts Benefits of Adjuvant Radiotherapy in Patients With High Grade Meningioma. Front Oncol 2020; 10:568079. [PMID: 33240812 PMCID: PMC7683714 DOI: 10.3389/fonc.2020.568079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/12/2020] [Indexed: 12/21/2022] Open
Abstract
Objective Adjuvant radiotherapy is the main treatment modality for high grade meningioma after surgical resection; however, recurrence and survival outcomes vary. The aim of this study was to create a new “prognostic score” that allows personalized recommendations for post-operative adjuvant radiotherapy in patients with high grade meningioma. Methods Clinical data were collected from 115 patients with high grade meningioma treated with surgical resection and adjuvant radiotherapy. A prognostic model was built based on the hazards ratios of independent prognostic factors yielded by multivariate cox proportional analysis. Calibration and discrimination of the prognostic score was evaluated using good of fit test and Harrel’s C index, respectively. Results A total of 115 high grade meningioma patients (72 atypical and 43 anaplastic meningiomas) were enrolled. Three factors were independently associated with progression-free survival (PFS): extent of resection (GTR vs. STR), recurrent status (de novo vs. recurrent), and Ki-67 labeling index (<5% vs. ≥ 5%). The respective β-coefficients were used to generate the “prognostic score”. The cohort was divided into low-risk and high-risk groups based on the median prognostic score. Good of fit test showed strong calibration (P = 0.7133) and Harrel’s C index 0.766 indicated a strong discrimination capability of the prognostic score. The Harrel’s C index for OS was 0.60. Conclusions Our prognostic model using three basic clinical parameters robustly separated high grade meningioma patients who benefit vs. do not benefit from adjuvant radiotherapy. External validation of our model is warranted to help improve patient selection suitable for adjuvant radiotherapy.
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Affiliation(s)
- Daijun Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shuchen Sun
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lingyang Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaojiao Deng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shihai Luan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haixia Cheng
- Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Hongda Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Critical Care Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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21
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Mirian C, Skyrman S, Bartek J, Jensen LR, Kihlström L, Förander P, Orrego A, Mathiesen T. The Ki-67 Proliferation Index as a Marker of Time to Recurrence in Intracranial Meningioma. Neurosurgery 2020; 87:1289-1298. [PMID: 32614441 DOI: 10.1093/neuros/nyaa226] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/27/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There are examples of incongruence between the WHO grade and clinical course in meningioma patients. This incongruence between WHO grade and recurrence has led to search for other prognostic histological markers. OBJECTIVE To study the correlation between the Ki-67 proliferative index (PI), risk of recurrence, and recurrence rates in meningioma patients. METHODS We prospectively collected pathological diagnosis of de novo consecutive meningiomas. In total, we followed 159 patients with clinical controls until recurrence, death, or emigration. We estimated the correlation between risk of recurrence and Ki-67 PI when adjusted for age at diagnosis, sex, WHO grade, extent of surgical resection, and tumor location. We estimated the cumulative incidence of recurrence when considering death without recurrence a competing risk. We report recurrence rates per 100 person-years. RESULTS A 1%-point increase of Ki-67 PI yielded a hazard ratio of 1.12 (95% CI: 1.01-1.24) in a multivariate analysis. The cumulative incidence of recurrence was 3% for Ki-67 0% to 4% vs 19% for Ki-67 > 4% meningiomas after 1 yr, but 24% vs 35%, respectively, after 10 yr. There was no significant difference in mean Ki-67 PI between nonrecurrent and recurrent meningioma in a 2-sample t-test (P = .08). The strongest relationship was detected between Ki-67 PI and time to recurrence: Ki-67 < 4% meningiomas recurred after median 4.8 yr, compared to 0.60 to 0.75 yr for patients with higher Ki-67 PI. CONCLUSION Ki-67 PI was a marker for time to recurrence rather than a predictor of recurrence. Ki-67 PI may be utilized for patient tailored follow-up.
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Affiliation(s)
- Christian Mirian
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simon Skyrman
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiri Bartek
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lasse Rehné Jensen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Kihlström
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Petter Förander
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Abiel Orrego
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Tiit Mathiesen
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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22
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Kwon SM, Kim JH, Yoo HJ, Kim YH, Hong SH, Cho YH, Kim CJ, Nam SJ. Predictive factors for high-grade transformation in benign meningiomas. Clin Neurol Neurosurg 2020; 195:105897. [PMID: 32505062 DOI: 10.1016/j.clineuro.2020.105897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/11/2020] [Accepted: 05/03/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Although they are generally slow-growing benign tumors, meningiomas may recur after surgery with transformation into atypical meningiomas. The purpose of this study was to investigate the radiological and histopathological factors that predict the risk of tumor progression from a benign to an atypical meningioma. PATIENTS AND METHODS All patients treated for recurrent meningiomas in whom the tumor showed histopathologically confirmed high-grade transformation (HGT) from a benign to an atypical meningioma between 2001 and 2017 were included. To evaluate the predictors of transformation, patient medical records documenting the diagnosis of a benign meningioma at the first surgery prior to second surgery with HGT were reviewed. Each patient was matched with four age- and sex-matched controls who were treated for a benign meningioma. The control group comprised all patients without any recurrence for at least 60 months. RESULTS Fourteen patients with benign meningioma underwent HGT and were included. The median time interval of transformation was 63 months (range, 19-132 months). Multivariate analysis indicated that an increased mitotic index (odds ratio [OR], 10.409; 95 % confidence interval [CI], 1.297-83.549; P = 0.027) was a significant predictor of transformation. Prominent peritumoral edema (OR, 33.822; 95 % CI, 0.935-223.688; P = 0.054) did not reach the statistical significance. CONCLUSION An increased mitotic index may be used as the predictor for HGT of benign meningiomas. Although these tumors with a high risk for transformation do not meet the diagnostic criteria for atypical meningiomas, they may require more attentive observation and management than other benign meningiomas.
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Affiliation(s)
- Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Hee Jun Yoo
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang Jin Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soo Jeong Nam
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Ye W, Ding-Zhong T, Xiao-Sheng Y, Ren-Ya Z, Yi L. Factors Related to the Post-operative Recurrence of Atypical Meningiomas. Front Oncol 2020; 10:503. [PMID: 32351890 PMCID: PMC7174970 DOI: 10.3389/fonc.2020.00503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
Aim: This study aimed to investigate the relationship between clinicopathological characteristics of atypical meningiomas (AM) and its post-operative recurrence. Materials and Methods: The clinicopathological characteristics and findings from follow up were retrospectively reviewed and compared between AM and benign meningioma (BM) patients. Univariate and multivariate analyses were employed to identify the factors related to the post-operative recurrence of AM. Results: More BM patients were females and received complete resection; the recurrence rate was significantly lower in BM patients as compared to AM patients. The progesterone receptor (PR), E-cadherin protein (E-Ca) and β-catenin positive rates and Ki67 labeling index were significantly different between two groups. Univariate analysis showed the age, tumor size, tumor invasiveness, E-Ca expression, and extent of resection were related to the post-operative recurrence of AM. However, multivariate analysis showed only the extent of resection and tumor invasiveness were the independent factors associated with the post-operative recurrence of AM. Conclusions: The extent of resection and tumor invasiveness are related to the post-operative recurrence of AM. To improve the surgical procedures to maximize the tumor resection is important to improve the prognosis of AM patients.
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Affiliation(s)
- Wu Ye
- Department of Neurosurgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Tang Ding-Zhong
- Department of Neurology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - Yang Xiao-Sheng
- Department of Neurosurgery, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhan Ren-Ya
- Department of Neurosurgery, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | - Li Yi
- Department of Neurosurgery, School of Medicine, Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Fioravanzo A, Caffo M, Di Bonaventura R, Gardiman MP, Ghimenton C, Ius T, Maffeis V, Martini M, Nicolato A, Pallini R, Pegolo E, Pinna G, Sala F, Skrap M, Volpin V, Barresi V. A Risk Score Based on 5 Clinico-Pathological Variables Predicts Recurrence of Atypical Meningiomas. J Neuropathol Exp Neurol 2020; 79:500-507. [PMID: 32232472 DOI: 10.1093/jnen/nlaa018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/22/2019] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
The use of adjuvant radiotherapy is controversial in patients with atypical meningiomas treated with gross total resection (GTR). This study aimed to determine whether clinico-pathological features could be helpful to predict the recurrence risk in this group of patients and to identify high-risk ones who could benefit from adjuvant treatment. We collected 200 patients with primary atypical meningiomas treated with GTR but with no adjuvant radiotherapy from 5 different centers. A risk score, formulated by assigning 1 point for the presence and 0 points for the absence of 5 high-risk parameters (male sex, parasagittal site, Simpson grade 3, mitotic index ≥ 6/10 HPF, and sheeting), was the most significant predictor of recurrence. A score ≥2 was associated with 4.7 risk of shorter disease-free survival (p < 0.0001). Our findings indicate that the presence of at least 2 clinico-pathological high-risk factors predicts recurrence of totally resected primary atypical meningiomas and could be helpful for identifying patients who could benefit from adjuvant radiotherapy.
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Affiliation(s)
- Adele Fioravanzo
- From the Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Italy
| | - Maria Caffo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Neurosurgery, University of Messina, Italy
| | | | - Marina Paola Gardiman
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), Padova University Hospital, Padova, Italy
| | - Claudio Ghimenton
- Department of Pathology and Diagnostics, Unit of Pathology, Hospital Trust of Verona, Italy
| | - Tamara Ius
- Department of Neurosurgery, University Hospital of Udine, Italy
| | - Valeria Maffeis
- Department of Pathology and Diagnostics, Unit of Pathology, Hospital Trust of Verona, Italy
| | - Maurizio Martini
- Unit of Anatomic Pathology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Nicolato
- Department of Neurosciences, Unit of Stereotaxic Neurosurgery, Hospital Trust of Verona, Verona, Italy
| | - Roberto Pallini
- Unit of Neurosurgery, Catholic University of Sacred Heart, Rome, Italy
| | - Enrico Pegolo
- Unit of Anatomic Pathology, University Hospital of Udine, Italy
| | - Giampietro Pinna
- Department of Neurosciences, Unit of Neurosurgery, Hospital Trust of Verona, Verona, Italy
| | - Francesco Sala
- Department of Neurosciences, Unit of Neurosurgery, Hospital Trust of Verona, Verona, Italy
| | - Miran Skrap
- Department of Neurosurgery, University Hospital of Udine, Italy
| | | | - Valeria Barresi
- From the Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Italy
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Abstract
BACKGROUND Ki-67 is a typical immunohistochemical marker for cell proliferation. Higher expression of Ki-67 is correlated with poor clinical outcomes in several cancers. However, the prognostic value of Ki-67 on the prognosis of meningiomas is still controversial. The purpose of this meta-analysis was to evaluate the prognostic value of Ki-67 in meningiomas. METHODS AND MATERIALS We searched Medline and EMBASE from inception to December 31, 2018, to identify relevant articles. Using a fixed or random effects model, pooled hazard ratios (HRs) for overall survival (OS) and disease/progression/recurrence-free survival (D/P/RFS) were estimated. RESULTS A total of 43 studies, comprising 5012 patients, were included in this analysis. Higher Ki-67 expression levels were significantly associated with worse OS (HR = 1.565; 95% CI: 1.217-2.013) and D/P/RFS (HR = 2.644; 95% CI: 2.264-3.087) in meningiomas. Subgroup analysis revealed that all the included factors (ethnicity, tumor grade, HR sources, definition of cutoffs, cutoff values) for heterogeneity investigation can affect the pooled results. Among them, the definitions of cutoffs and cutoff values factor are the two main contributors toward heterogeneity. Multivariable meta-regression analysis also showed that methodologies used for cutoff value definition contributed to the high inner-study heterogeneity. CONCLUSIONS Higher Ki-67 expression levels negatively influenced survival in meningiomas. A higher cutoff value (>4%) is more appropriate for prognosis prediction. It is highly recommended that Ki-67 expression profile could be assessed in meningiomas treatment for predicting survival. And patients with elevated expression of Ki-67 need to have close follow-ups.
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Affiliation(s)
- Ning Liu
- Department of Neurosurgery, Sanbo Brain Hospital
| | - Si-Ying Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University
| | - Jia-Bao Jiang
- Department of Basic Medicine, Fuzhou Medical College, Nanchang University
| | - Ting-Jian Wang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, China
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Rami A, Suzan E, Rafeed A, Nooruddeen AM, Lamees A, Duaa A, Hussam AN, Amer AS. The Sovereignty of Primary Cranial Tumors-Meningiomas: Vetting the Cardinal Epidemiological Features. Med Arch 2019; 72:434-438. [PMID: 30814776 PMCID: PMC6340618 DOI: 10.5455/medarh.2018.72.434-438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Cranial meningiomas considered one of most frequently encountered primary intracranial tumors in our daily neurosurgical practice, represent about 36% of brain neoplasms. Aim: In this cohort analysis, we investigated epidemiological features of brain meningiomas diagnosed at a single institution. Special highlighting has been dedicated to demographic features, foretelling radiological signs, and concomitant factors predictive of tumor atypia. Material and Methods: This retrospective analysis was conducted by revising all medical registries of patients aged ≥18 years, with a diagnosis of brain meningioma treated at King Hussein Medical Center, patients were retrieved from the electronic hospital database during a 12-year period (2004 to 2015). Preoperative radiology reports were examined to confirm tumor site and size based on largest measured dimension. Level of resection was based on surgical operative reports and post-operative radiological imaging. Results: A total of 665-patients operated for intracranial meningiomas were analyzed out of total 2047-patients operated for intracranial neoplasm during the same period. Demographic analysis showed; female to male ratio 2.4:1. Mean age 49.6-years. Average follow-up of 8.7 years. Tumor locations were classified as parasagittal (39.55%), convexity (27.52%), tentorial/ falx (6.17%), intraventricular (2.04%). Mean tumor size was 3,86 cm and tumor size was >4.5cm in (28. 07%) of cases. In this study we achieved gross total resection in (73.1%) of cases, subtotal resection in (22.6%). The majority of patients evolved favorably with respect to their neurological examination post-operatively, though a neurological deficit persisted in 64-cases and 16-cases developed a new neurological deficit. Ninety five cases developed recurrence during the observation period. Surgical mortality was reported in 11-cases in the immediate post-operative period and in 42-cases further cases during the observation period related to other causes. Conclusion: Neurosurgery faces a large number of intracranial meningioma patients in daily practice. Because of its “benign” nature; the variability in management strategy, Neurosurgery is more and more challenged with the concern of intracranial meningioma treatment in the daily practice. Because of its “benign” nature; the variability in management strategy, research regarding the meningioma etiology and epidemiology has lagged behind that for more malignant intracranial neoplasms. These risk factors piloted a revitalization in the study of meningiomas.
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Affiliation(s)
- Alqroom Rami
- Neurosurgery Department, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Eteiwi Suzan
- Endocrinology Department, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Aldrous Rafeed
- Neurosurgery Department, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | | | - Arabiyat Lamees
- Plastic Surgery Department at Farah Center, Royal Medical Services, Amman, Jordan
| | - Alshurbaji Duaa
- Pathology Department at Princess Iman Research and Laboratory Sciences Center, Amman, Jordan
| | - Abu Nowar Hussam
- Neurosurgery Department, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Al Shurbaji Amer
- Neurosurgery Department, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
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Nakada S, Sasagawa Y, Tachibana O, Iizuka H, Kurose N, Shioya A, Guo X, Yamada S, Nojima T. The clinicopathological analysis of receptor tyrosine kinases in meningiomas: the expression of VEGFR-2 in meningioma was associated with a higher WHO grade and shorter progression-free survival. Brain Tumor Pathol 2019; 36:7-13. [PMID: 30519894 DOI: 10.1007/s10014-018-0332-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
WHO grade II/III meningiomas recur frequently and there is currently no established molecular target therapy for meningioma. No previous studies have revealed the association between receptor tyrosine kinases (RTKs) and the recurrence of meningiomas. This study aims to elucidate the association between RTKs and the clinicopathological characteristics and recurrence of meningioma. We investigated the immunohistochemical expression of RTKs (VEGFR-1/2/3, PDGFR-alpha/beta and c-Kit) in 81 meningiomas (WHO grade I, n = 64, WHO grade II/III, n = 17) in 74 patients. Immunohistochemistry revealed that 29 WHO grade I (45%), 10 WHO grade II (77%), and 4 WHO grade III (100%) tumors were VEGFR-2-positive, and that the VEGFR-2 expression was significantly correlated with the WHO grade. In univariate analyses to investigate the clinicopathological factors associated with recurrence, Simpson grade IV/V resection, a larger tumor size, a high VEGFR-2 expression level, WHO grade II/III, a high Ki-67 expression level, and the non-expression of PgR were identified as significant factors. Furthermore, patients with VEGFR-2-positive meningiomas showed significantly shorter progression-free survival. In the multivariate analysis, WHO grade II/III and the location were significantly associated with recurrence. In conclusion, our study suggests that VEGFR-2 inhibitors might be one of the best candidates for molecular therapy against recurrent meningiomas.
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Li J, Deng X, Zhang S, Wang Q, Cheng J, Li X, Ke D, Hui X. Intracranial clear cell meningioma: Clinical study with long-term follow-up in 24 patients. Clin Neurol Neurosurg 2018; 175:74-83. [DOI: 10.1016/j.clineuro.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
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30
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Budohoski KP, Clerkin J, Millward CP, O'Halloran PJ, Waqar M, Looby S, Young AMH, Guilfoyle MR, Fitzroll D, Devadass A, Allinson K, Farrell M, Javadpour M, Jenkinson MD, Santarius T, Kirollos RW. Predictors of early progression of surgically treated atypical meningiomas. Acta Neurochir (Wien) 2018; 160:1813-1822. [PMID: 29961125 PMCID: PMC6105233 DOI: 10.1007/s00701-018-3593-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/11/2018] [Indexed: 02/06/2023]
Abstract
Background Clinical behaviour of atypical meningiomas is not uniform. While, as a group, they exhibit a high recurrence rate, some pursue a more benign course, whereas others progress early. We aim to investigate the imaging and pathological factors that predict risk of early tumour progression and to determine whether early progression is related to outcome. Methods Adult patients with WHO grade II meningioma treated in three regional referral centres between 2007 and 2014 were included. MRI and pathology characteristics were assessed. Gross total resection (GTR) was defined as Simpson 1–3. Recurrence was classified into early and late (≤ 24 vs. > 24 months). Results Among the 220 cases, 37 (16.8%) patients progressed within 24 months of operation. Independent predictors of early progression were subtotal resection (STR) (p = 0.005), parafalcine/parasagittal location (p = 0.015), peritumoural oedema (p = 0.027) and mitotic index (MI) > 7 (p = 0.007). Adjuvant radiotherapy was negatively associated with early recurrence (p = 0.046). Thirty-two per cent of patients with residual tumour and 26% after GTR received adjuvant radiotherapy. There was a significantly lower proportion of favourable outcomes at last follow-up (mRS 0–1) in patients with early recurrence (p = 0.001). Conclusions Atypical meningiomas are a heterogeneous group of tumours with 16.8% patients having recurrence within 24 months of surgery. Residual tumour, parafalcine/parasagittal location, peritumoural oedema and a MI > 7 were all independently associated with early recurrence. As administration of adjuvant radiotherapy was not protocolised in this cohort, any conclusions about benefits of irradiation of WHO grade II meningiomas should be viewed with caution. Patients with early recurrence had worse neurological outcome. While histological and imaging characteristics provide some prognostic value, further molecular characterisation of atypical meningiomas is warranted to aid clinical decision making.
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Affiliation(s)
- Karol P Budohoski
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK.
| | - James Clerkin
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | | | | | - Mueez Waqar
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Seamus Looby
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Adam M H Young
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
| | - Mathew R Guilfoyle
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
| | - Diana Fitzroll
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
| | - Abel Devadass
- Department of Neuropathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Kieren Allinson
- Department of Neuropathology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | | | | | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Thomas Santarius
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
| | - Ramez W Kirollos
- Division of Neurosurgery, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Box 167, Cambridge, CB2 0QQ, UK
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