A Prognostic Gene-Expression Signature and Risk Score for Meningioma Recurrence After Resection.

Abstract

Prognostic markers for meningioma are needed to risk-stratify patients and guide postoperative surveillance and adjuvant therapy. To identify a prognostic gene signature for meningioma recurrence and mortality after resection using targeted gene-expression analysis. Targeted gene-expression analysis was used to interrogate a discovery cohort of 96 meningiomas and an independent validation cohort of 56 meningiomas with comprehensive clinical follow-up data from separate institutions. Bioinformatic analysis was used to identify prognostic genes and generate a gene-signature risk score between 0 and 1 for local recurrence. We identified a 36-gene signature of meningioma recurrence after resection that achieved an area under the curve of 0.86 in identifying tumors at risk for adverse clinical outcomes. The gene-signature risk score compared favorably to World Health Organization (WHO) grade in stratifying cases by local freedom from recurrence (LFFR, P <.001vs .09, log-rank test), shorter time to failure (TTF, F-test, P <.0001), and overall survival (OS, P <.0001vs .07) and was independently associated with worse LFFR (relative risk [RR] 1.56, 95% CI 1.30-1.90) and OS (RR 1.32, 95% CI 1.07-1.64), after adjusting for clinical covariates. When tested on an independent validation cohort, the gene-signature risk score remained associated with shorter TTF (F-test, P=.002), compared favorably to WHO grade in stratifying cases by OS (P=.003vs P=.10), and was significantly associated with worse OS (RR 1.86, 95% CI 1.19-2.88) on multivariate analysis. The prognostic meningioma gene-expression signature and risk score presented may be useful for identifying patients at risk for recurrence.