Prognostic value of estrogen receptor in WHO Grade III meningioma: a long-term follow-up study from a single institution

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OBJECTIVE

Malignant meningioma is rare and classified as Grade III in the WHO classification of CNS tumors. However, the presence of estrogen receptor (ER) in WHO Grade III meningiomas and its correlation with patients’ outcomes are still unclear. In this single-center cohort study, the authors analyzed clinical features, treatment, and prognosis of these malignant tumors in patients with long-term follow-up.

METHODS

A total of 87 patients who were pathologically diagnosed with WHO Grade III meningiomas between 2003 and 2008 were enrolled in this study and followed for at least 7 years. Clinical information was collected to analyze the factors determining the prognosis.

RESULTS

Twelve patients with rhabdoid, 12 with papillary, and 63 with anaplastic meningioma were included. The mean progression-free survival (PFS) and overall survival (OS) were 56.2 ± 49.8 months and 68.7 ± 47.4 months, respectively. No significant differences were observed among the 3 histological subtypes in either PFS (p = 0.929) or OS (p = 0.688). Patients who received gross-total resection had a longer PFS (p = 0.001) and OS (p = 0.027) than those who received subtotal resection. Adjuvant radiotherapy was associated with OS (p = 0.034) but not PFS (p = 0.433). Compared with primary meningiomas, patients with recurrent disease had worse PFS (p < 0.001). For patients who had malignant transformations, the prognosis was poorer than for patients without malignant transformations for both PFS (p = 0.002) and OS (p = 0.019). ER-positive patients had a significantly worse prognosis than ER-negative patients regarding both PFS (p = 0.003) and OS (p < 0.001), whereas no association between progesterone receptor and patients’ outcomes was observed. Multivariate analysis demonstrated that ER expression was an independent prognostic factor for both PFS (p = 0.008) and OS (p < 0.001).

CONCLUSIONS

This retrospective study showed that patients with meningioma with ER-positive expression had a much worse prognosis than those with ER weak–positive or ER-negative status. The results demonstrated that ER is an independent prognostic factor for both PFS and OS of patients with WHO Grade III meningioma. The authors also found that more radical resection of the tumor, as well as postoperative radiotherapy, may prolong patients’ survival time.

ABBREVIATIONS EMA = epithelial membrane antigen; ER = estrogen receptor; GTR = gross-total resection; KPS = Karnofsky Performance Scale; OS = overall survival; PFS = progression-free survival; PR = progesterone receptor; STR = subtotal resection; Vim = vimentin.

Article Information

Correspondence Ye Gong, Departments of Neurosurgery and Critical Care Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Rd., Jingan District, Shanghai 200040, China. email: drgongye@163.com.

INCLUDE WHEN CITING Published online August 18, 2017; DOI: 10.3171/2017.2.JNS162566.

Drs. Hua and Zhu contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Kaplan-Meier survival curves. A: PFS and OS of patients by histological subtypes. B: PFS and OS of patients by tumor location. C: PFS and OS of patients by the extent of tumor resection. D: PFS and OS of patients by absence or presence of postoperative radiotherapy.

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    Kaplan-Meier survival curves. A: PFS and OS of patients by primary or recurrent meningioma. B: PFS and OS of patients by absence or presence of malignant transformation.

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    Kaplan-Meier survival curves. A: PFS and OS of patients by ER expression. B: PFS and OS of patients by PR expression.

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