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Apoptotic activity and bcl-2 immunoreactivity in meningiomas. Association with grade and outcome
1Dept of Anatomic Pathology (L25), Cleveland Clinic Foundation, OH 44195, USA.
Abstract:
We retrospectively evaluated 90 meningiomas for bcl-2 expression, apoptosis counts (per 10 high-power fields [HPF]), MIB-1 labeling indices (LI), and mitosis counts (per 10 HPF). Characteristics were as follows: 37 low-grade (benign) meningiomas: mean apoptosis count, 1.2; MIB-1 LI, 1.0; mitosis count, 0.1; and bcl-2 positivity, 40%; 29 atypical meningiomas: apoptosis count, 3.3; MIB-1 LI, 5.5; mitosis count, 2.2; and bcl-2 positivity, 62%; 24 malignant meningiomas: apoptosis count, 6.5; MIB-1 LI, 12.0; mitosis count, 6.0; and bcl-2 positivity, 67%. By univariate analysis, MIB-1 LI, apoptosis and mitosis counts, and tumor grade were associated significantly with death due to tumor; by multivariate analysis, only mitosis count was independently associated with death due to tumor. We compared similar data for 27 patients with nonrecurrent tumors and 32 patients with recurrent meningiomas. Histologic sections from the initially resected tumor and from the most recent recurrence were reviewed. Only the apoptosis count was significantly higher by univariate analysis in the initial resection specimens from tumors that ultimately recurred vs nonrecurrent tumors. Expression of bcl-2, MIB-1 LI, and mitosis count did not correlate with recurrence. By multivariate analysis, only extent of surgical resection was associated significantly with tumor recurrence. Although bcl-2 immunostaining was not associated statistically with outcome, bcl-2 positivity was more common in atypical and malignant meningiomas than in low-grade tumors.
Insights
Mitosis count is the key predictor of death in meningiomas. While apoptosis is higher in recurrent tumors, only surgical resection extent impacts recurrence risk.
Area of Science:
- Neuropathology
- Oncology
- Surgical Oncology
Background:
- Meningiomas are the most common primary intracranial tumors.
- Predicting meningioma behavior and recurrence is crucial for patient outcomes.
- The role of specific biomarkers in meningioma prognosis requires further elucidation.
Purpose of the Study:
- To evaluate the prognostic significance of bcl-2 expression, apoptosis, MIB-1 labeling index (LI), and mitosis count in meningiomas.
- To identify predictors of tumor-related death and recurrence in meningioma patients.
Main Methods:
- Retrospective analysis of 90 meningioma cases.
- Assessment of bcl-2 expression, apoptosis counts, MIB-1 LI, and mitosis counts.
- Correlation of these factors with tumor grade, patient survival, and recurrence.
Main Results:
- Mitosis count was the sole independent predictor of death due to tumor.
- Higher apoptosis counts were observed in tumors that recurred.
- Extent of surgical resection was significantly associated with tumor recurrence.
- bcl-2 positivity increased with tumor grade but did not correlate with outcome or recurrence.
Conclusions:
- Mitosis count is a critical prognostic indicator for meningioma-related mortality.
- Tumor recurrence is primarily influenced by the extent of surgical resection.
- While apoptosis may indicate higher risk, it is not an independent predictor of recurrence in this cohort.