Abstract
BackgroundThe 2016 WHO histopathological grade or conventional biomarker MIB-1 is insufficient for predicting meningioma recurrence after initial treatment and alternative strategies are required. In this study, we investigated whether DNA topoisomerase IIα and/or mitosin expression can predict tumor recurrence with greater accuracy than conventional methods.MethodsThe expression of MIB-1, topoisomerase IIα, and mitosin were determined as proliferation indices in tissue microarrays using immunohistochemistry. The accuracy of prognostication was assessed with receiver operating characteristic (ROC) analyses and standard survival analyses.ResultsExpression of topoisomerase IIα and mitosin was significantly higher in recurrent meningioma than in non-recurrent meningioma (P ≤ 0.031), but no difference in MIB-1 expression was observed (P = 0.854). ROC analysis found topoisomerase IIα and mitosin expression to be the most reliable predictors of recurrence compared to WHO histopathological grade and MIB-1 expression. This result was supported by the multivariate survival analysis, in which mitosin expression was a significant predictor of recurrence-free survival (P < 0.001) and no association was found with histopathological grade or MIB-1 expression (P ≥ 0.158).ConclusionsThe results suggest that topoisomerase IIα and mitosin improve prognostication of patients resected for meningioma. Tumors with higher topoisomerase IIα and/or mitosin expression have a higher risk of recurrence after initial treatment, and these patients may benefit from adjuvant treatment and closer radiological follow-up.
Highlights
Meningioma is the most commonly reported primary brain tumor and accounts for more than one-third of such tumors [1]
receiver operating characteristic (ROC) analysis found topoisomerase IIα and mitosin expression to be the most reliable predictors of recurrence compared to World Health Organization (WHO) histopathological grade and MIB-1 expression
This result was supported by the multivariate survival analysis, in which mitosin expression was a significant predictor of recurrence-free survival (P < 0.001) and no association was found with histopathological grade or MIB-1 expression (P ! 0.158)
Summary
Meningioma is the most commonly reported primary brain tumor and accounts for more than one-third of such tumors [1]. A substantial proportion of tumors are associated with a greater likelihood of recurrence after surgery, or even death; such tumors correspond histopathologically to atypical and malignant meningiomas (Grade II and III, respectively) [2, 3]. The most important prognostic question regarding meningioma implies the prediction of recurrence after initial treatment [2, 3]. Up to 71% and 50% of atypical and malign meningiomas, respectively, have indolent behavior with no recurrence [2, 3, 5] These findings suggest that the histopathological grade is inadequate for predicting recurrence in patients resected for meningioma, and alternative methods are required for optimal decisionmaking regarding treatment of these patients. We investigated whether DNA topoisomerase IIα and/or mitosin expression can predict tumor recurrence with greater accuracy than conventional methods
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