Artikel
Enhanced angiogenesis in grade I meningiomas is associated with tumour recurrence and characteristical findings on magnetic resonance imaging
Erhöhte Angiogenese in Grad I Meningeomen ist assoziiert mit erhöhter Rezidivrate und charakteristischen Veränderungen in der Bildgebung
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Autoren
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Katharina Heß
- Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
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Dorothee Cäcilia Spille
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Alborz Adeli
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
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Peter B. Sporns
- Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster, Deutschland
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Werner Paulus
- Universitätsklinikum Münster, Institut für Neuropathologie, Münster, Deutschland
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Walter Stummer
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
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Benjamin Brokinkel
- Universitätsklinikum Münster, Klinik und Poliklinik für Neurochirurgie, Münster, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Although generally considered benign, recurrences in more than 20% after surgery for grade I meningiomas have been described. Hence, determination of risk factors associated with recurrence is crucial during perioperative care of meningioma patients. Increased microvascular density has been demonstrated in high grade meningiomas and was therefore associated with worse outcome, but a radiological correlate could not be determined. We here demonstrate preliminary results of a current study, investigating the potential role of preoperative MRI findings and tumor associated angiogenesis for predicting postoperative recurrence in grade I meningiomas.
Methods: Correlations between magnetic resonance imaging findings (tumor volume, disruption of the arachnoid layer (DAL), peritumoral edema volume, heterogeneity, heterogeneous tumor shape (hTS), capsular contrast-enhancement and calcifications) and tumor progression were investigated in 299 patients (79 men, 26%; 220 women, 74%) with grade I meningiomas. Moreover, tissue samples from each patient were histopathologically evaluated for vessel density (VD) and pathological blood vessels (PBV) with increased vessel wall thickness by EvG-staining.
Results: Pathological blood vessels were strongly correlated with VD (p=.000), DAL (p=.000), hTS (p=.018) and calcification (p=.017). In multivariable analyses, PBV was strongly associated with the tumor volume (OR: 1.00; 95%CI 1.00–1.00; p=.017) and DAL (OR: 4.32, 95%CI 2.63–7.08; p<.001). Within a median follow-up of 38 months, recurrence was observed in 38 patients (13%). PBV (HR: 5.11, 95%CI .267–.981, p=.043) and DAL (HR: 2.84, 95%CI 1.39–5.80; p=.004) were strongly correlated with tumor progression/recurrence. In multivariate analyses adjusted for patient’s age, sex, extent of resection and all included radiological variables, DAL (HR: 3.18, 95%CI 1.27–7.97; p=.014) and PBV (HR: 1.96, 95%CI 1.02–3.75, p=.043) were identified as the only independent predictors for tumor recurrence.
Conclusion: DAL and PBV were identified as new and independent predictors for progression in grade I meningiomas. The underlying mechanism of tumor angiogenesis and the association with DAL need to be further investigated in meningiomas.
