Biological and Demographic Profile of Meningiomas in a Cohort of Egyptian Patients: Impact on Tumor Recurrence

Eman Abdelzaher,Ahmed Yehya,Nevine M F El Deeb,Ahmed G Gowil

doi:10.1155/2013/375139

Abstract

Objective. This work was designed to study the biological and demographic characteristics of meningiomas and their impact on tumor recurrence in Egyptian patients. Material and Methods. A cohort of 265 Egyptian patients with meningioma was studied. Immunohistochemistry for VEGF, Ki67, PR, CD20, and CD3 was performed. Statistical analysis was used to detect independent predictors of recurrence. Results. Adults represented 98.9% of cases, with female preponderance (M : F ratio = 1 : 2.4). Histologically, 78.10% of cases were grade I, 19.20% were grade II, and 2.60% were grade III. Transitional variant was the most common (43.40%). VEGF expression (38.50% of cases) correlated positively with perifocal edema, tumor size, and proliferative index (PI). PR expression (64.5% of cases) correlated inversely with the PI (mean 3.75). Lymphocytic aggregates were detected in 7.20% of cases, with a mean CD20 : CD3 ratio of 1 : 10.1. In a multivariate analysis, only tumor size, PR expression and necrosis predicted recurrence independently. Using ROC curve, size was the best predictor of tumor recurrence with a cut-off point of >6 cm and an excellent negative predictive value (97.6%). Conclusions. Meningiomas in our region showed some distinctive clinicopathological and demographic criteria. Tumor size was found to be the best recurrence predictor factor of meningioma.

Highlights

Meningiomas, deriving from meningothelial cells, are the most common primary intracranial and spinal intradural neoplasms [1].Despite their prevalence among central nervous system (CNS) tumors, their epidemiology, biological behavior, and clinical outcomes have been poorly defined
Recurrence was significantly associated with the following parameters: tumor grade (P < 0.001), tumor size (HR = 1.9; 95% CI = 1.5, 2.5; P < 0.001), nucleolar prominence (P = 0.044), necrosis (P < 0.001), vascular endothelial growth factor (VEGF) expression (HR = 1.6; 95% CI = 1.3, 1.9; P < 0.001), progesterone receptor (PR) expression (HR = 0.7; 95% CI = 0.6, 0.9; P < 0.001), and proliferative index (PI) (HR = 1.3; 95% CI = 1.2, 1.4; P < 0.001)
The present work showed that the studied cohort of meningioma patients had some demographic and clinicopathological criteria in common with meningioma patients from other countries, including predominant affection of adult female patients with supratentorial cerebral convexities being the most common site [2, 11, 12]; rarity in pediatric population [13]; infrequency of macrocysts [14]; predominance of benign grade I histology [2, 11, 12]; frequency of basal meningiomas [15]; and frequency of spinal meningiomas and their higher predilection for females, dorsal spine affection, and predominant benign histology [16]

Summary

Objective

This work was designed to study the biological and demographic characteristics of meningiomas and their impact on tumor recurrence in Egyptian patients. Statistical analysis was used to detect independent predictors of recurrence. VEGF expression (38.50% of cases) correlated positively with perifocal edema, tumor size, and proliferative index (PI). PR expression (64.5% of cases) correlated inversely with the PI (mean 3.75). Lymphocytic aggregates were detected in 7.20% of cases, with a mean CD20 : CD3 ratio of 1 : 10.1. Only tumor size, PR expression and necrosis predicted recurrence independently. Using ROC curve, size was the best predictor of tumor recurrence with a cut-off point of >6 cm and an excellent negative predictive value (97.6%). Tumor size was found to be the best recurrence predictor factor of meningioma

Introduction

Materials and Methods

Results

Discussion