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Takahashi Y, Oishi N, Yamao Y, Kunieda T, Kikuchi T, Fukuyama H, Miyamoto S, Arakawa Y. Voxel-based clustered imaging by multiparameter diffusion tensor images for predicting the grade and proliferative activity of meningioma. Brain Behav 2023; 13:e3201. [PMID: 37644780 PMCID: PMC10570481 DOI: 10.1002/brb3.3201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/18/2023] [Accepted: 07/22/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Meningiomas are the most common primary central nervous system tumors. Predicting the grade and proliferative activity of meningiomas would influence therapeutic strategies. We aimed to apply the multiple parameters from preoperative diffusion tensor images for predicting meningioma grade and proliferative activity. METHODS Nineteen patients with low-grade meningiomas and eight with high-grade meningiomas were included. For the prediction of proliferative activity, the patients were divided into two groups: Ki-67 monoclonal antibody labeling index (MIB-1 LI) < 5% (lower MIB-1 LI group; n = 18) and MIB-1 LI ≥ 5% (higher MIB-1 LI group; n = 9). Six features, diffusion-weighted imaging, fractional anisotropy, mean, axial, and radial diffusivities, and raw T2 signal with no diffusion weighting, were extracted as multiple parameters from diffusion tensor imaging. The two-level clustering approach for a self-organizing map followed by the K-means algorithm was applied to cluster a large number of input vectors with the six features. We also validated whether the diffusion tensor-based clustered image (DTcI) was helpful for predicting preoperative meningioma grade or proliferative activity. RESULTS The sensitivity, specificity, accuracy, and area under the curve of receiver operating characteristic curves from the 16-class DTcIs for differentiating high- and low-grade meningiomas were 0.870, 0.901, 0.891, and 0.959, and those from the 10-class DTcIs for differentiating higher and lower MIB-1 LIs were 0.508, 0.770, 0.683, and 0.694, respectively. The log-ratio values of class numbers 13, 14, 15, and 16 were significantly higher in high-grade meningiomas than in low-grade meningiomas (p < .001). With regard to MIB-1 LIs, the log-ratio values of class numbers 8, 9, and 10 were higher in meningiomas with higher MIB-1 groups (p < .05). CONCLUSION The multiple diffusion tensor imaging-based parameters from the voxel-based DTcIs can help differentiate between low- and high-grade meningiomas and between lower and higher proliferative activities.
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Affiliation(s)
- Yuki Takahashi
- Department of NeurosurgeryKyoto University Graduate School of MedicineKyotoJapan
- Human Brain Research CenterKyoto University Graduate School of MedicineKyotoJapan
| | - Naoya Oishi
- Department of PsychiatryKyoto University Graduate School of MedicineKyotoJapan
| | - Yukihiro Yamao
- Department of NeurosurgeryKyoto University Graduate School of MedicineKyotoJapan
- Human Brain Research CenterKyoto University Graduate School of MedicineKyotoJapan
| | - Takeharu Kunieda
- Department of NeurosurgeryEhime University Graduate School of MedicineToonJapan
| | - Takayuki Kikuchi
- Department of NeurosurgeryKyoto University Graduate School of MedicineKyotoJapan
| | | | - Susumu Miyamoto
- Department of NeurosurgeryKyoto University Graduate School of MedicineKyotoJapan
- Stroke Support CenterKyoto University HospitalKyotoJapan
- Momoya Disease Support CenterKyoto University HospitalKyotoJapan
| | - Yoshiki Arakawa
- Department of NeurosurgeryKyoto University Graduate School of MedicineKyotoJapan
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Ren L, Hua L, Deng J, Cheng H, Wang D, Chen J, Xie Q, Wakimoto H, Gong Y. Favorable Long-Term Outcomes of Chordoid Meningioma Compared With the Other WHO Grade 2 Meningioma Subtypes. Neurosurgery 2023; 92:745-755. [PMID: 36512828 PMCID: PMC9988284 DOI: 10.1227/neu.0000000000002272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND WHO grade 2 meningiomas, including atypical, chordoid, and clear cell subtypes, form a heterogenous group of meningiomas with varying aggressiveness and clinical behavior. OBJECTIVE To demonstrate the differences of clinical-histopathological characteristics and long-term outcomes among these 3 subtypes. METHODS A total of 609 consecutive patients diagnosed with WHO grade 2 meningiomas (543 atypical meningiomas [AMs], 36 chordoid meningiomas [CMs], and 30 clear cell meningiomas [CCMs]) from 2010 to 2018 were enrolled in this study. We compared the clinical-histopathological characteristics and long-term outcomes in these 3 subtypes and assessed survival differences among the subtypes. Targeted panel sequencing of meningioma-relevant genes was performed in the cases of CM. RESULTS The patients with CCM were significantly younger than those with AM ( P < .001) and CM ( P = .016). CMs were more likely to receive gross total resection than AMs and CCMs ( P = .033). The Ki-67 index was lower ( P < .001) while the progesterone receptors-positive rate was higher ( P = .034) in CM than in AM and CCM. Importantly, survival analysis demonstrated that CM had better progression-free survival ( P = .022) and overall survival ( P = .0056) than non-CM tumors. However, the PFS of CM was still worse than WHO grade 1 meningiomas ( P < .001). Alterations in NF2 (20.6%) and KMT2C (26.5%) were associated with poorer PFS in CM ( P = .013 for NF2 ; P = .021 for KMT2C ). CONCLUSION Patients with CM had better long-term postoperative outcomes than the other WHO grade 2 subtypes. A lower Ki-67 index, higher PR status, higher extent of resection, and lower frequency of NF2 alteration might contribute to favorable clinical outcomes of CM.
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Affiliation(s)
- Leihao Ren
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Lingyang Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Jiaojiao Deng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Haixia Cheng
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Daijun Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Jiawei Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
- Department of Critical Care Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Ren L, Cheng H, Chen J, Deng J, Wang D, Xie Q, Wakimoto H, Hua L, Gong Y. Progesterone receptor expression and prediction of benefits of adjuvant radiotherapy in de novo atypical meningiomas after gross-total resection. J Neurosurg 2022:1-10. [DOI: 10.3171/2022.9.jns221530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Benefits of adjuvant radiotherapy (ART) after gross-total resection (GTR) of de novo atypical meningiomas (AMs) are controversial, and factors predictive of radiotherapy benefits in patients with de novo AMs after GTR are unknown. The authors aimed to evaluate the benefits of ART and explore potential factors sensitizing AMs to ART.
METHODS
A total of 231 consecutive patients who were pathologically diagnosed with de novo AMs and treated with GTR (Simpson class I–III resections) from 2010 to 2018 were enrolled in the study. Clinicopathological and prognostic information was collected and analyzed. Univariate and multivariate Cox analyses were used to evaluate prognostic predictors and compare the response to radiotherapy. Propensity score matching (PSM) was used to balance the confounding bias in subgroups.
RESULTS
A total of 138 patients (59.74%) received ART. Progesterone receptor (PR) expression was positive in 157 patients (67.97%). During the mean follow-up period of 76.25 months, 65 patients (28.14%) experienced recurrence and 38 (16.45%) died of tumor progression. For disease-specific survival (DSS), ART was a better prognostic factor via univariate (p = 0.003) and multivariate (p = 0.025) analyses. For progression-free survival (PFS), univariate Cox analysis showed that ART improved PFS (p = 0.013), but multivariate analysis did not (p = 0.068). Positive PR expression (p = 0.019), age 53.5 years or younger (p = 0.012), and Ki-67 7.5% or lower (p = 0.025) were independent prognostic predictors for better PFS. In the subcohort analysis, the beneficial impact of ART was observed in the PR-negative cohort (p = 0.002) but not in the PR-positive cohort (p = 0.86). The heterogeneity analysis demonstrated that the PR-negative cohort was more sensitive to ART than the PR-positive cohort (p = 0.036). ART was not found to be associated with better PFS in younger patients (≤ 53.5 years, p = 0.14), older patients (> 53.5 years, p = 0.085), those with a Ki-67 index ≤ 7.5% (p = 0.068), or those with a Ki-67 > 7.5% (p = 0.13). The contrasting effects of ART in the PR-negative versus PR-positive cohorts remained true even after PSM, confirming that PR-negative, but not PR-positive, de novo AMs benefited from ART after GTR.
CONCLUSIONS
ART was an independent prognostic factor for DSS of patients with de novo AMs treated with GTR (p = 0.025), but not for PFS (p = 0.068). Negative PR expression was a radiosensitive biomarker on PFS for de novo AM patients after GTR.
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Affiliation(s)
- Leihao Ren
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | | | - Jiawei Chen
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Jiaojiao Deng
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Daijun Wang
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Qing Xie
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lingyang Hua
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
| | - Ye Gong
- Departments of Neurosurgery,
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China; and
- Pathology, and
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Chiba K, Sugawara T, Kobayashi D, Sato A, Murota Y, Maehara T. Atypical Histological Features as Risk Factors for Recurrence in Newly Diagnosed WHO Grade I Meningioma. Neurol Med Chir (Tokyo) 2021; 61:647-651. [PMID: 34470989 PMCID: PMC8592816 DOI: 10.2176/nmc.oa.2021-0153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The significance of atypical histological features (AHF) as risk factors for recurrence in benign meningioma is not well understood. This study examined risk factors of World Health Organization (WHO) Grade I meningioma (GIM) recurrence, focusing on AHF. We investigated 150 consecutive newly diagnosed GIM patients who had more than one year of follow-up after resection in our hospital between January 2007 and March 2018. The following factors were reviewed retrospectively: age, sex, tumor location, extent of resection, MIB-1 index, mitotic figures, number and distribution of AHF, and recurrence. The patients were grouped according to the presence or absence of recurrence and comparatively examined. Recurrence was observed in 10 cases (6.7%). Univariate analysis showed that patients with recurrence had a significantly higher MIB-1 index (2.0 vs. 4.3; p = 0.006) and a significantly higher proportion of male patients (21.4% vs. 70.0%; p = 0.002) and patients with sheet-like growth (6.42% vs. 30.0%; p = 0.04). In multivariate analysis, skull base location (odds ratio [OR] 31.424; 95% confidence interval [CI] 1.74–569), gross total resection (OR 0.130; 95% CI 0.0189–0.897), and MIB-1 index (OR 1.939; 95% CI 1.19–3.15) were significantly associated with recurrence. Our study revealed that skull base location, subtotal resection, and high MIB-1 index were independent risk factors for recurrence. Only the presence of sheet-like growth had a significantly higher incidence in patients with recurrence in univariate analysis of AHF. Multivariate analysis found no significant association. Sheet-like growth may be involved in malignancy and recurrence of benign meningioma.
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Affiliation(s)
- Keitaro Chiba
- Department of Neurosurgery, Tokyo Medical and Dental University
| | | | | | - Akihito Sato
- Department of Neurosurgery, Tokyo Medical and Dental University
| | - Yasuhiro Murota
- Department of Neurosurgery, Tokyo Medical and Dental University
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Sofela AA, McGavin L, Whitfield PC, Hanemann CO. Biomarkers for differentiating grade II meningiomas from grade I: a systematic review. Br J Neurosurg 2021; 35:696-702. [PMID: 34148477 DOI: 10.1080/02688697.2021.1940853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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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Kuranari Y, Tamura R, Tsuda N, Kosugi K, Morimoto Y, Yoshida K, Toda M. Prognostic Significance of Preoperative Neutrophil-to-Lymphocyte Ratio in Patients With Meningiomas. Front Oncol 2020; 10:592470. [PMID: 33330078 PMCID: PMC7732694 DOI: 10.3389/fonc.2020.592470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Meningiomas are the most common benign intracranial tumors. However, even WHO grade I meningiomas occasionally show local tumor recurrence. Prognostic factors for meningiomas have not been fully established. Neutrophil-to-lymphocyte ratio (NLR) has been reported as a prognostic factor for several solid tumors. The prognostic value of NLR in meningiomas has been analyzed in few studies. Materials and Methods This retrospective study included 160 patients who underwent surgery for meningiomas between October 2010 and September 2017. We analyzed the associations between patients’ clinical data (sex, age, primary/recurrent, WHO grade, extent of removal, tumor location, peritumoral brain edema, and preoperative laboratory data) and clinical outcomes, including recurrence and progression-free survival (PFS). Results Forty-four meningiomas recurred within the follow-up period of 3.8 years. WHO grade II, III, subtotal removal, history of recurrence, Ki-67 labeling index ≥3.0, and preoperative NLR value ≥2.6 were significantly associated with shorter PFS (P < 0.001, < 0.001, 0.002, < 0.001, and 0.015, respectively). Furthermore, NLR ≥ 2.6 was also significantly associated with shorter PFS in a subgroup analysis of WHO grade I meningiomas (P = 0.003). In univariate and multivariate analyses, NLR ≥2.6 remained as a significant predictive factor for shorter PFS in patients with meningioma (P = 0.014). Conclusions NLR may be a cost-effective and novel preoperatively usable biomarker in patients with meningiomas.
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Affiliation(s)
- Yuki Kuranari
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Tsuda
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yukina Morimoto
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Oya S, Yoshida S, Tsuchiya T, Fujisawa N, Mukasa A, Nakatomi H, Saito N, Matsui T. Intraoperative quantification of meningioma cell proliferation potential using rapid flow cytometry reveals intratumoral heterogeneity. Cancer Med 2019; 8:2793-2801. [PMID: 30993844 PMCID: PMC6558493 DOI: 10.1002/cam4.2178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/07/2019] [Accepted: 04/05/2019] [Indexed: 12/12/2022] Open
Abstract
Background Standard sampling methods to evaluate the proliferative ability of meningioma have not been established. Methods This prospective study was conducted to evaluate the effectiveness of intraoperative rapid flow cytometry (iFC) using raw samples for the quantitative assessment of proliferative ability in meningioma cells and to investigate intratumoral heterogeneity. Proliferation index (PI) was defined as the ratio of aneuploid cells with an abnormal number of chromosomes to the total cells. Results From 50 patients, 118 specimens were analyzed. There was a statistically significant correlation between the postoperative MIB‐1 labeling index (LI) and PI (R = 0.59, P < 0.0001). A higher PI was correlated with a higher annual growth rate (AGR, cm3/y) (R = 0.50, P = 0.0002, 26 patients). AGR showed a correlation with the intratumoral distribution of PI. PI was the highest at the center or the peripheral section of the tumor in tumors with high AGR, whereas it was highest at the dural attachment in tumors with low AGR (P = 0.039, n = 20). Pial feeders were more frequently observed when PI was high in the center or in the peripheral section (P = 0.006, n = 37). Conclusions Rapid iFC may thus become a substitute for MIB‐1 LI. Intratumoral heterogeneity of cellular proliferative potential exists in meningiomas and is related to tumor biological characteristics such as AGR and development of pial feeders. This observation underscores the importance of standardization in the sampling method to accurately estimate the risk of meningioma recurrence.
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Affiliation(s)
- Soichi Oya
- Department of NeurosurgerySaitama Medical Center, Saitama Medical UniversitySaitamaJapan
| | - Shinsuke Yoshida
- Department of NeurosurgerySaitama Medical Center, Saitama Medical UniversitySaitamaJapan
| | - Tsukasa Tsuchiya
- Department of NeurosurgerySaitama Medical Center, Saitama Medical UniversitySaitamaJapan
| | - Naoaki Fujisawa
- Department of NeurosurgerySaitama Medical Center, Saitama Medical UniversitySaitamaJapan
| | - Akitake Mukasa
- Department of NeurosurgeryGraduate School of Medicine, The University of TokyoTokyoJapan
| | - Hirofumi Nakatomi
- Department of NeurosurgeryGraduate School of Medicine, The University of TokyoTokyoJapan
| | - Nobuhito Saito
- Department of NeurosurgeryGraduate School of Medicine, The University of TokyoTokyoJapan
| | - Toru Matsui
- Department of NeurosurgerySaitama Medical Center, Saitama Medical UniversitySaitamaJapan
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Richard SA, Zheng S, Xuehua X, Bowen C, You C. A giant invasive parasagittal meningioma with recurrent seizures in a young female: A case report and review of literature. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2019. [DOI: 10.1016/j.inat.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chordoid meningioma: a clinico-pathological study of an uncommon variant of meningioma. J Neurooncol 2018; 137:575-582. [DOI: 10.1007/s11060-018-2748-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
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Prabhu VC, Melian E, Germanwala AV, Solanki AA, Borys E, Barton K, Anderson DE. Cranial Base Meningiomas. World Neurosurg 2017; 109:258-262. [PMID: 29017978 DOI: 10.1016/j.wneu.2017.09.207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Vikram C Prabhu
- Department of Neurological Surgery, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA; Department of Radiation Oncology, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA.
| | - Edward Melian
- Department of Neurological Surgery, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA; Department of Radiation Oncology, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA
| | - Anand V Germanwala
- Department of Neurological Surgery, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA; Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA
| | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA
| | - Ewa Borys
- Department of Pathology, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA
| | - Kevin Barton
- Department of Oncology, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA
| | - Douglas E Anderson
- Department of Neurological Surgery, Loyola University Medical Center/Stritch School of Medicine, Maywood, Illinois, USA
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Karsy M, Burnett B, Di Ieva A, Cusimano MD, Jensen RL. Microvascularization of Grade I meningiomas: effect on tumor volume, blood loss, and patient outcome. J Neurosurg 2017; 128:657-666. [PMID: 28362240 DOI: 10.3171/2016.10.jns161825] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Quantitative assessment of tumor microvascularity has the potential to improve prognostication, advance understanding of tumor biology, and help narrow potential molecular therapies. While the role of tumor microvascularity has been widely studied in meningiomas, this study examines both the role of automated measurements and the impact on surgical outcome. METHODS Two hundred seven patients with Grade I meningiomas underwent surgery between 1996 and 2011. Tissue samples from each patient were retrospectively evaluated for histopathological measures of microvascularity, including staining for von Willebrand factor (vWF), CD31, CD105, hypoxia-inducible factor 1 (HIF-1), vascular endothelial growth factor, glucose transporter 1, and carbonic anhydrase IX. Manual methods of assessing microvascularity were supplemented by a computational analysis of the microvascular patterns by means of fractal analysis. MIB-1 proliferation staining was also performed on the same tumors. These measures were compared with various patient characteristics, tumor volume, estimated blood loss (EBL) during surgery, progression-free survival (PFS), and overall survival (OS). RESULTS The mean patient age was 55.4 ± 14.8 years, and 63 (30.4%) patients were male. Patients harboring tumors ≥ 3 cm were significantly older (56.9 ± 15.2 years vs 53.1 ± 13.6 years; p = 0.07), more frequently male (40.8% vs 14.6%; p = 0.0001), and had greater EBL (446.5 ± 532.2 ml vs 185.4 ± 197.2 ml; p = 0.0001), greater tumor volume (33.9 ± 38.1 ml vs 29.4 ± 23.5 ml; p = 0.0001), higher MIB-1 index values (3.0% ± 5.4% vs 1.7% ± 1.7%; p = 0.03), higher vWF levels (85.6% ± 76.9% vs 54.1% ± 52.4%; p = 0.001), lower HIF-1 expression (1.4 ± 1.3 vs 2.2 ± 1.4; p = 0.004), and worse OS (199.9 ± 7.6 months vs 180.8 ± 8.1 months; p = 0.05) than patients with tumors < 3 cm. In the multivariate logistic regression, MIB-1 (OR 1.14; p = 0.05), vWF (OR 1.01; p = 0.01), and HIF-1 (OR 1.54; p = 0.0001) significantly predicted tumor size. Although multiple factors were predictive of EBL in the univariate linear regression, only vWF remained significant in the multivariate analysis (β = 0.39; p = 0.004). Lastly, MIB-1 was useful via Kaplan-Meier survival analysis for predicting patients with disease progression, whereby an MIB-1 cutoff value of ≥ 3% conferred a 36% sensitivity and 82.5% specificity in predicting disease progression; an MIB-1 value ≥ 3% showed significantly shorter mean PFS (140.1 ± 11.7 months vs 179.5 ± 7.0 months; log-rank test, p = 0.05). The Cox proportional hazards model showed a trend for MIB-1 in predicting disease progression in a hazards model (OR 1.08; 95% CI 0.99-1.19; p = 0.08). CONCLUSIONS These results support the importance of various microvascularity measures in predicting preoperative (e.g., tumor size), intraoperative (e.g., EBL), and postoperative (e.g., PFS and OS) outcomes in patients with Grade I meningiomas. An MIB-1 cutoff value of 3% showed good specificity for predicting tumor progression. The predictive ability of various measures to detect aberrant tumor microvasculature differed, possibly reflecting the heterogeneous underlying biology of meningiomas. It may be necessary to combine assays to understand angiogenesis in meningiomas.
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Affiliation(s)
| | - Brian Burnett
- 1Department of Neurosurgery and.,2Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Antonio Di Ieva
- 3Neurosurgery Unit, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales,Australia; and
| | - Michael D Cusimano
- 4Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario,Canada
| | - Randy L Jensen
- 1Department of Neurosurgery and.,2Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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Johnson M, O'Connell M, Walter K. STAT3 activation and risk of recurrence in meningiomas. Oncol Lett 2017; 13:2432-2436. [PMID: 28454415 DOI: 10.3892/ol.2017.5736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
Several studies have suggested that activation of signal transducer and activator of transcription 3 (STAT3) is associated with initiation, progression and metastasis of numerous types of malignancy. However, the role of the Janus kinase-interleukin 6-STAT3 signaling pathway in the pathogenesis and recurrence of meningiomas is unknown. The present study evaluated STAT3 activation by western blotting and immunohistochemistry and assessed its association with Ki-67 labeling in 13 cases of meningioma in which frozen tissue and ≥5.5-year follow-up information were available, and in formalin-fixed meningioma tissues from 14 cases with an 8.4-year follow-up. The results of the western blot analysis indicated that STAT3 phosphorylation was markedly higher in grade II meningiomas compared with that in grade I, with mean densitometric values of 8.6 and 1.7 following normalization to actin, respectively. High STAT3 phosphorylation/activation was identified in 2 of 3 recurrent World Health Organization (WHO) grade I meningiomas and 0 of 3 non-recurrent meningiomas. Strong STAT3 phosphorylation/activation signal was also found in 2 of 4 recurrent grade II meningiomas and 1 of 3 non-recurrent cases. According to the immunohistochemistry results, phospho-STAT3 was not increased in WHO grade II tumors compared with that in grade I tumors, and was not significantly different between recurrent and non-recurrent cases. Ki-67 labeling was significantly increased in grade II vs. grade I tumors, and was also significantly increased in recurrent compared with non-recurrent grade I meningiomas. The results of the current study suggest that, while detection of phosphorylated/activated STAT3 may be useful in isolated cases, identifying activation may be of little value in predicting recurrence.
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Affiliation(s)
- Mahlon Johnson
- Department of Pathology, Division of Neuropathology, University of Rochester, Rochester, NY 14623, USA
| | - Mary O'Connell
- Department of Pathology, Division of Neuropathology, University of Rochester, Rochester, NY 14623, USA
| | - Kevin Walter
- Department of Neurosurgery, University of Rochester, Rochester, NY 14623, USA
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Prabhu VC, Perry EC, Melian E, Barton K, Guo R, Anderson DE. Intracranial meningiomas in individuals under the age of 30; Analysis of risk factors, histopathology, and recurrence rate. ACTA ACUST UNITED AC 2014. [DOI: 10.7243/2052-6946-2-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Skull base meningiomas: neurological outcome after microsurgical resection. J Neurooncol 2013; 116:381-6. [DOI: 10.1007/s11060-013-1309-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/10/2013] [Indexed: 10/26/2022]
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Oya S, Kawai K, Nakatomi H, Saito N. Significance of Simpson grading system in modern meningioma surgery: integration of the grade with MIB-1 labeling index as a key to predict the recurrence of WHO Grade I meningiomas. J Neurosurg 2012; 117:121-8. [PMID: 22559847 DOI: 10.3171/2012.3.jns111945] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Techniques for the surgical treatment of meningioma have undergone many improvements since Simpson established the neurosurgical dogma for meningioma surgery in his seminal paper published in 1957. This study aims to assess the clinical significance and limitations of the Simpson grading system in relation to modern surgery for WHO Grade I benign meningiomas and to explore the potential of the cell proliferation index to complement the limitations in predicting their recurrence. METHODS The surgical records of patients who underwent resection of intracranial meningiomas at the University of Tokyo Hospital between January 1995 and August 2010 were retrospectively analyzed. The authors investigated the relationships between recurrence-free survival (RFS) and Simpson grade or MIB-1 labeling index value. RESULTS A total of 240 patients harboring 248 benign meningiomas were included in this study. Simpson Grade IV resection was associated with a significantly shorter RFS than Simpson Grade I, II, or III resection (p<0.001), while no statistically significant difference was noted in RFS between Simpson Grades I, II, and III. Among meningiomas treated by Simpson Grade II and III resections, however, multivariate analysis revealed that an MIB-1 index of 3% or higher was associated with a significantly shorter time to recurrence. CONCLUSIONS The clinical significance of the different management strategies related to Simpson Grade I-III resection may have been diluted in the modern surgical era. The MIB-1 index can differentiate tumors with a high risk of recurrence, which could be beneficial for planning tailored optimal follow-up strategies. The results of this study appear to provide a significant backing for the recent shift in meningioma surgery from attempting aggressive resection to valuing the quality of the patient's life.
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Affiliation(s)
- Soichi Oya
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan.
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Abry E, Thomassen IØ, Salvesen ØO, Torp SH. The significance of Ki-67/MIB-1 labeling index in human meningiomas: a literature study. Pathol Res Pract 2010; 206:810-5. [PMID: 20951502 DOI: 10.1016/j.prp.2010.09.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 07/16/2010] [Accepted: 09/03/2010] [Indexed: 11/17/2022]
Abstract
Histology alone does not always predict the clinical outcome of human meningiomas. Determination of proliferative activity has therefore become an important diagnostic and prognostic tool to identify more aggressive meningiomas, and the Ki-67/MIB-1 monoclonal antibody has become widely used. The aim of this study was to assess the prognostic value of the Ki-67/MIB-1 labeling index (LI) in human meningiomas by a search in the literature. In PubMed/Medline databases, 53 articles were found, and they all showed positive correlations between Ki-67/MIB-1 LI and histological malignancy grade. The average mean labeling indices were 3%, 8%, and 17% for grade I-III meningiomas, respectively. There was, however, considerable overlap of indices between the malignancy groups. Concerning recurrence, meningiomas with a labeling index beyond 4% may indicate an increased relapse rate. Consequently, Ki-67/MIB-1 LI represents a useful predictor of tumor grade and risk of recurrence, however, it must be interpreted cautiously in the individual tumor.
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Affiliation(s)
- Ellen Abry
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, University Hospital, Trondheim, Norway
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Rao S, Sadiya N, Doraiswami S, Prathiba D. Characterization of morphologically benign biologically aggressive meningiomas. Neurol India 2010; 57:744-8. [PMID: 20139503 DOI: 10.4103/0028-3886.59470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Meningiomas are presently categorized into three grades by World Health Organization (WHO). Grade I, in general, is expected to behave in a benign fashion. However, a borderline group of grade I meningioma also exists, which may behave aggressively. AIMS AND OBJECTIVE To evaluate the proliferation index and p53 antigen expression of meningiomas and correlate with histological grade and clinical course. MATERIALS AND METHODS All 123 cases of meningiomas, diagnosed between January 2000 and August 2007, were regraded according to WHO 2000 criteria. Immunostaining for Ki-67 antigen and p53 protein were performed on 68 cases selected for the study. RESULTS Six of the 68 cases presented with recurrence. Mean Ki-67 labeling index (Ki-67 LI) was 3.8%, 13.7%, 19.4% for grade I, II, and III cases, respectively. Multivariate analysis of mean Ki-67 LI showed statistically significant difference between subgroups. Mean p53 expression was found to be 15.5%, 57%, 60.8%, and 62.5% for grade I, II, III, and recurrent cases, respectively. Multivariate analysis of mean p53 expression showed no statistically significant difference between higher grades. All recurrent cases were histologically WHO grade I, and showed a high Ki-67 LI and p53 expression with mean Ki-67 LI and p53 expression of 8.6% and 62.5% respectively. CONCLUSION Utilization of markers for proliferation and cell cycle regulators in combination with histopathological features helps in the identification of a subset of biologically aggressive morphologically benign meningiomas.
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Affiliation(s)
- Shalinee Rao
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India
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Recurrence and regrowth of benign meningiomas. Brain Tumor Pathol 2009; 26:69-72. [PMID: 19856217 DOI: 10.1007/s10014-009-0251-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 03/12/2009] [Indexed: 10/20/2022]
Abstract
The World Health Organization (WHO) grading system for meningioma is helpful for predicting aggressive subtypes. However, even benign meningiomas sometimes show relatively rapid growth and may recur after total removal. We attempted to find histopathological features that would be valuable for predicting recurrence or regrowth of WHO grade I meningiomas. We investigated 135 benign meningiomas, of which 120 were totally removed (Simpson's grade I-III). The median follow-up period was 9.7 years (1-21 years). The recurrence rate in the patients with total removal was 7.5% at 10 years and 9.3% at 20 years. The univariate analysis revealed that MIB-1 index (>or=2%), existence of mitosis, absence of calcification, and paucity of fibrosis significantly correlated with recurrence. On the other hand, the histological features of sheet-like growth, prominent nucleoli, and necrosis did not correlate with recurrence, because they were relatively rare in grade I tumors. Multivariate analysis revealed that high MIB-1 index and absence of calcification significantly correlated with recurrence. The patients with recurrent or residual tumors did not always receive adjuvant treatment. Including subtotally treated tumors, the retreatment rate was 9.8% at 10 years and 25.6% at 20 years. MIB-1 index and Simpson's grade significantly correlated with retreatment in both univariate and multivariate analyses.
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Iatrogenic metastasis of a benign meningioma to the periosteum at the site of previous craniotomy: a case report. Wien Klin Wochenschr 2009; 120:766-9. [PMID: 19122989 DOI: 10.1007/s00508-008-1068-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 09/04/2008] [Indexed: 12/19/2022]
Abstract
Metastasis formation after resection of meningiomas is a rare event, predominantly occurring with malignant phenotypes. As far as we know, the presented case is the first report in the literature of iatrogenic seeding of a benign meningioma to the scalp following surgery. A 37-year-old woman was admitted because of a relapsing meningioma in the frontal lobe. In 1997, she had undergone complete excision of an atypical meningioma in same location. At follow-up, three new masses were found: a bifrontal meningioma on the edge of the falx, a smaller one in the falx just under the saggital sinus and a small mass, believed to be ectopic, in the periosteum at the site of the previous craniotomy. Surgical therapy was indicated. Histologically, the ectopic tumor was an atypical meningioma, similar to the one excised 10 years previously, with no relation to the other two intracranial masses. Because of the histological similarity and the location in the old craniotomy, the ectopic tumor was believed to have developed from an implantation metastasis as a consequence of the first surgery. The authors suggest that strict adherence to oncological principles should be applied in the case of benign neoplasms in order to prevent contamination of wounds with tumor cells and potential recurrence.
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99mTc-Tetrofosmin brain SPECT in the assessment of meningiomas—correlation with histological grade and proliferation index. J Neurooncol 2008; 89:225-30. [DOI: 10.1007/s11060-008-9611-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 04/22/2008] [Indexed: 11/25/2022]
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