Significance of Simpson grading system in modern meningioma surgery: integration of the grade with MIB-1 labeling index as a key to predict the recurrence of WHO Grade I meningiomas

Oya, Soichi; Kawai, Kensuke; Nakatomi, Hirofumi; Saito, Nobuhito

doi:10.3171/2012.3.jns111945

Cited by 195 publications

(155 citation statements)

References 40 publications

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“…Here we revealed that genotype was associated with recurrence independently from the degree of surgical resection completeness (Simpson grade) and histological malignancy (Ki-67 LI and WHO grade), which is known as prognostic factors in meningioma. [32][33][34] TRAKLS type was the most favorable genotype, so in addition to evaluating NF2 status, identifying this genotype from non-NF2 meningioma may help the accurate assessment of the recurrent risk. More recently, TERT promoter and PIK3CA mutations were reported to be associated with highly aggressive behavior or tumorigenesis in meningioma.…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of targeted amplicon sequencing for meningioma as a practical clinical-sequencing system

et al. 2016

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Recent genetic analyses using next-generation sequencers have revealed numerous genetic alterations in various tumors including meningioma, which is the most common primary brain tumor. However, their use as routine laboratory examinations in clinical applications for tumor genotyping is not cost effective. To establish a clinical sequencing system for meningioma and investigate the clinical significance of genotype, we retrospectively performed targeted amplicon sequencing on 103 meningiomas and evaluated the association with clinicopathological features. We designed amplicon-sequencing panels targeting eight genes including NF2 (neurofibromin 2), TRAF7, KLF4, AKT1, and SMO. Libraries prepared with genomic DNA extracted from PAXgenefixed paraffin-embedded tissues of 103 meningioma specimens were sequenced using the Illumina MiSeq. NF2 loss in some cases was also confirmed by interphase-fluorescent in situ hybridization. We identified NF2 loss and/or at least one mutation in NF2, TRAF7, KLF4, AKT1, and SMO in 81 out of 103 cases (79%) by targeted amplicon sequencing. On the basis of genetic status, we categorized meningiomas into three genotype groups: NF2 type, TRAKLS type harboring mutation in TRAF7, AKT1, KLF4, and/or SMO, and 'not otherwise classified' type. Genotype significantly correlated with tumor volume, tumor location, and magnetic resonance imaging findings such as adjacent bone change and heterogeneous gadolinium enhancement, as well as histopathological subtypes. In addition, multivariate analysis revealed that genotype was independently associated with risk of recurrence. In conclusion, we established a rapid clinical sequencing system that enables final confirmation of meningioma genotype within 7 days turnaround time. Our method will bring multiple benefits to neuropathologists and neurosurgeons for accurate diagnosis and appropriate postoperative management.

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Section: Discussionmentioning

confidence: 99%

Clinical impact of targeted amplicon sequencing for meningioma as a practical clinical-sequencing system

et al. 2016

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“…Indeed, this is even a controversy for benign meningiomas (WHO Grade I). For benign meningiomas, some authors reported that Simpson Grade I-III resection yielded equivalent results, 31,58,74 while others have advocated for Simpson Grade I or even more radical resection. 28,42,79 This issue becomes even more ambiguous for AMs.…”

Section: Surgical Managementmentioning

confidence: 99%

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Sun¹,

Hawasli²,

Huang

et al. 2015

FOC

116

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The management of WHO Grade II “atypical” meningiomas (AMs) and Grade III “malignant” meningiomas (MMs) remains controversial and under-investigated in prospective studies. The roles of surgery, radiation therapy, radiosurgery, and chemotherapy have been incompletely delineated. This has left physicians to decipher how they should treat patients on a case-by-case basis. In this study, the authors review the English-language literature on the management and clinical outcomes associated with AMs and MMs diagnosed using the WHO 2000/2007 grading criteria. Twenty-two studies for AMs and 7 studies for MMs were examined in detail. The authors examined clinical decision points using the literature and concepts from evidence-based medicine. Acknowledging the retrospective nature of the studies concerning AM and MM, the authors did find evidence for the following clinical strategies: 1) maximal safe resection of AM and MM; 2) active surveillance after gross-total resection of AM; 3) adjuvant radiation therapy after subtotal resection of AM, especially in the absence of putative radioresistant features; and 4) adjuvant radiation therapy after resection of MM.

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“…Like others, we believe that there is a subgroup of Grade I meningiomas that demonstrate more aggressive clinical behavior. The MIB-1 labeling index has become a popular tool for predicting recurrence of Grade I meningiomas, 13 although the optimal cutoff has not yet been established. It is possible that markers such as the MIB-1 labeling index may help explain why multifocal meningiomas are more likely to recur both locally and distantly.…”

Section: Multifocal Diseasementioning

confidence: 99%

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

Kuhn¹,

Taksler

Dayton

et al. 2013

FOC

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Object The purpose of this study was to evaluate patterns of failure after stereotactic radiosurgery (SRS) for meningiomas and factors that may influence these outcomes. Methods Based on a retrospective chart review, 279 patients were treated with SRS for meningiomas between January 1999 and March 2011 at Wake Forest Baptist Health. Disease progression was determined using serial imaging, with a minimum follow-up of 6 months (median 34.2 months). Results The median margin dose was 12.0 Gy (range 8.8–20 Gy). Local control rates for WHO Grade I tumors were 96.6%, 84.4%, and 75.7% at 1, 3, and 5 years, respectively. WHO Grade II and III tumors had local control rates of 72.3%, 57.7%, and 52.9% at 1, 3, and 5 years, respectively. Tumors without pathological grading had local control rates of 98.7%, 97.6%, and 94.2% at 1, 3, and 5 years, respectively. Of the local recurrences, 63.1% were classified as marginal (within 2 cm of treatment field). The 1-, 3-, and 5-year rates of distant failure were 6.5%, 10.3%, and 16.6%, respectively, for Grade I tumors and 11.4%, 17.2%, and 22.4%, respectively, for Grade II/III tumors. Tumors without pathological grading had distant failure rates of 0.7%, 3.2%, and 6.5% at 1, 3, and 5 years, respectively. Wilcoxon analysis revealed that multifocal disease (p < 0.001) and high-grade histology (WHO Grade II or III; p < 0.001) were significant predictors of local recurrence. Additionally, male sex was a significant predictor of distant recurrence (p = 0.04). Multivariate analysis also showed that doses greater than or equal to 12 Gy were associated with improved local control (p = 0.015). Conclusions In this patient series, 12 Gy was the minimum sufficient margin dose for the treatment of meningiomas. Male sex is a risk factor for distant failure, whereas high-grade histology and multifocal disease are risk factors for local failure.

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Significance of Simpson grading system in modern meningioma surgery: integration of the grade with MIB-1 labeling index as a key to predict the recurrence of WHO Grade I meningiomas

Cited by 195 publications

References 40 publications

Clinical impact of targeted amplicon sequencing for meningioma as a practical clinical-sequencing system

Clinical impact of targeted amplicon sequencing for meningioma as a practical clinical-sequencing system

An evidence-based treatment algorithm for the management of WHO Grade II and III meningiomas

Patterns of recurrence after stereotactic radiosurgery for treatment of meningiomas

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