Abstract
BackgroundThe progesterone receptor (PR) is variably expressed in most meningiomas and was found to have prognostic significance. However, the correlation with patient age, tumor location, time to recurrence, and pattern of regrowth has scarcely been discussed.MethodsA surgical series of 300 patients with meningiomas is reviewed. The PR expression was classified as: 0. absent; 1. low (<15%); 2. moderately low (16–50%); 3. moderately high (51–79%); 4. high (≥80%). The PR values were correlated with the patient age and sex, meningioma location, WHO grade, Ki-67 MIB1, recurrence rate, pattern of recurrence (local-peripheral versus multicentric diffuse), and time to recurrence.ResultsThe PR expression has shown lower rate of high expression in the elderly group (p = 0.032) and no sex difference (including premenopausal versus postmenopausal women), higher expression in medial skull base and spinal versus other locations (p = 0.0036), inverse correlation with WHO grade and Ki67-MIB1 (p < 0.0001). Meningiomas which recurred showed at initial surgery higher rates of low or moderately low PR expression than the non-recurrent ones (p = 0.0004), whereas the pattern of regrowth was not significant. Higher rates of PR values ≥80% were found in cases with time to recurrence >5 years (p = 0.036).ConclusionThe higher PR expression in medial skull base meningiomas, the significant correlation with the time to recurrence, the lack of difference of PR expression between premenopausal and postmenopausal women and between local-peripheral versus multicentric-diffuse recurrences are the most relevant unreported findings of this study. The rate of PR expression must be included in the routine pathological diagnosis of meningiomas because of its prognostic significance.
Highlights
The presence of sex steroid hormone receptors in meningiomas is known since about 40 years [1, 2].Some clinical evidence suggests that sex steroids play a role in the growth of meningiomas; these include the clear female predominance, the reported rapid growth during pregnancy [3, 4], and women who receive oral contraceptives or hormone replacement therapy [5, 6]
In a recent report [51], we studied the expression of p40, a shorter form of the p53 homolog gene p63, in a series of WHO I and II meningiomas; it was found to be significantly associated with Ki67 LI and recurrence and inversely correlated with the progesterone receptor (PR) expression
The higher PR expression in medial skull base meningiomas, the significant correlation with the recurrence time, the lack of difference of PR expression between premenopausal and postmenopausal women and between local-peripheral versus multicentric-diffuse recurrences are the main findings of this study
Summary
The presence of sex steroid hormone receptors in meningiomas is known since about 40 years [1, 2].Some clinical evidence suggests that sex steroids play a role in the growth of meningiomas; these include the clear female predominance (female/male ratio 2:1), the reported rapid growth during pregnancy [3, 4], and women who receive oral contraceptives or hormone replacement therapy [5, 6]. The presence of sex steroid hormone receptors in meningiomas is known since about 40 years [1, 2]. The progesterone receptor (PR) expression is found in variable and often very high rate meningiomas (39 to 88%) in some studies [7,8,9], whereas the estrogen receptor (ER) expression is lower than 10% and often undetectable. Other factors, including patient age, intracranial tumor location, spinal meningiomas, time to recurrence, and patterns of regrowth, have scarcely been discussed. This study reviews a surgical series of meningiomas and discusses the pathological correlation and prognostic significance of the PR expression. The progesterone receptor (PR) is variably expressed in most meningiomas and was found to have prognostic significance. The correlation with patient age, tumor location, time to recurrence, and pattern of regrowth has scarcely been discussed
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