Article
Proliferative potential and the inflammatory tumour microenvironment in meningioma correlate with neurological function at presentation, and anatomical location – from convexity to skull base and spine
Proliferationspotenzial und inflammatorisches Tumormikromilieu in Meninigomen korrelieren mit der initialen neurologischen Funktion und der anatomischen Lokalisation: Von der Konvexität über die Schädelbasis bis zur Wirbelsäule
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Published: | May 25, 2022 |
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Objective: Emerging evidence emphasizes the prognostic importance of meningioma location. The present investigation evaluates whether progression-free survival (PFS), proliferative potential, WHO grades, and inflammatory burden differ between anatomical locations (skull base, non-skull base, and spinal) meningiomas.
Methods: Five-hundred-forty-one cranial and spinal meningioma patients underwent Simpson grade I or II resection for WHO grade 1 or 2 meningiomas. The inclusion criteria of this study were histopathologically confirmed meningioma, an age greater than 18 years, the availability of neuropathology reports (MIB-I, mitotic count, CD68+ staining), and serum as well as plasma inflammatory laboratory values (fibrinogen & C-reactive protein).
Results: Univariable analysis revealed that spinal meningioma patients are significantly older, had a worse baseline Karnofsky Performance Status (KPS), higher acute-phase protein levels, lower incidence of WHO grade 2, lower mitotic counts, lower MIB-1 indices, and less CD68+ macrophage infiltrates. Furthermore, location-specific meningioma deficits such as seizure burden, cranial nerve deficits, and ambulatory ability were significantly associated with the MIB-1 indices in convexity, skull base, and spinal meningiomas. Multivariable analysis identified WHO grade 2 (OR:2.1, 95%CI: 1.1-3.7, p=0.02) and cranial location (OR:3.0, 95%CI: 1.8-4.9, p=0.001) as independent predictors of diffuse CD68+ macrophage infiltrates. The mean PFS in cranial meningiomas was 115.9 months (95%CI: 107.5-124.3), compared to 162.2 months (95%CI: 150.5-174.0; log-rank test: p=0.02) in spinal meningiomas. Multivariable Cox regression analysis revealed cranial location as an independent predictor (HR:4.7, 95%CI: 1.0-21.3, p=0.04) of shortened PFS.
Conclusion: Increased MIB-1 indices ≥5% were significantly associated with location-specific deficits at presentation such as decreased vision and seizure burden. Spinal meningiomas have a significantly longer PFS time and differ from the cranial meningiomas regarding MIB-1 index and density of tumor-associated macrophages.