Abstract
Simple SummaryMeningiomas are predominantly benign intracranial tumors, and surgical therapy represents the treatment of choice. However, the risk of recurrence and scheduling of follow-up intervals are significantly influenced by immunohistochemical items such as the MIB-1 labeling index. To date, it is not possible to integrate this essential information into the pre- or intraoperative surgical decision making. In the present study, we therefore analyzed baseline variables associated with the MIB-1 labeling index. We found four easily identifiable and routinely recorded risk factors for an increased MIB-1 index and developed a simple and quick-to-use score that allows us to estimate the risk of an elevated MIB-1 index prior to the surgical resection. Furthermore, this score seems to predict the progression-free survival in intracranial meningiomas. We believe that this score might us to more reliably guide patients in preoperative surgical strategy planning and postoperative follow-up scheduling.The MIB-1 index is an essential predictor of progression-free-survival (PFS) in meningioma. To date, the MIB-1 index is not available in preoperative treatment planning. A preoperative score estimating the MIB-1 index in patients with intracranial meningiomas has not been investigated so far. Between 2013 and 2019, 208 patients with tumor morphology data, MIB-1 index data, and plasma fibrinogen and serum C-reactive protein (CRP) data underwent surgery for intracranial WHO grade I and II meningioma. An optimal MIB-1 index cut-off value (≥6/<6) in the prediction of recurrence was determined by ROC curve analysis (AUC: 0.71; 95% CI: 0.55–0.87). A high MIB-1 index (≥6%) was present in 50 cases (24.0%) and was significantly associated with male sex, peritumoral edema, low baseline CRP, and low fibrinogen level in the multivariate analysis. A scoring system (“FORGE”) based on sex, peritumoral edema, preoperative CRP value, and plasma fibrinogen level supports prediction of the MIB-1 index (sensitivity 62%, specificity 79%). The MIB-1 labeling index and the FORGE score are significantly associated with an increased risk of poor PFS time. We suggest a novel score (“FORGE”) to preoperatively estimate the risk of an increased MIB-1 index (≥6%), which might help in surgical decision making and follow-up interval determination and inform future trials investigating inflammatory burden and proliferative activity.
Highlights
Meningiomas are generally considered to be predominantly benign neoplasms, which account for 36.4% of all central nervous system (CNS) tumors [1,2]
Numerous studies and a recent meta-analysis have shown that the Ki-67/Molecular Immunology Borstel 1 (MIB-1) labeling index is an independent predictor of progression-free survival (PFS) in meningiomas [10,11,12,13]
We intended to create a proposal for a new score displaying demographic, inflammation, and tumor characteristics in order to identify a population of meningioma patients at increased risk of a high MIB-1 labeling index
Summary
Meningiomas are generally considered to be predominantly benign neoplasms, which account for 36.4% of all central nervous system (CNS) tumors [1,2]. Benign WHO grade I meningiomas can recur, with previous investigations reporting a tumor recurrence rate of up to 47% over a 25 year long-term follow-up period [5]. To achieve the best possible long-term outcome with regard to tumor recurrence, appropriate preoperative assessment, effective communication about the aims of surgery, and function-preserving surgery are essential. We evaluated our patient population of sporadic intracranial WHO grade I and II meningiomas with regard to possible preoperative clinical, laboratory inflammatory markers and imaging risk factors for an increased MIB-1 labeling index. We intended to create a proposal for a new score displaying demographic, inflammation, and tumor characteristics in order to identify a population of meningioma patients at increased risk of a high MIB-1 labeling index
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