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Recurrence of meningiomas
F Yamasaki1, H Yoshioka, S Hama
1Department of Neurosurgery, Hiroshima University School of Medicine, Japan.
Background:
Macroscopic total resection with removal of involved dura and bone does not always prevent the recurrence of meningioma of histologically benign subtype. Many causative factors have been investigated, although the mechanism of recurrence remains unclear. Vascular endothelial growth factor (VEGF) is a key factor in meningiomas neovascularization, and the authors investigated whether VEGF expression can predict the recurrence of histologically benign meningiomas after macroscopic total resection.
Methods:
Fifty-four patients with supratentorial convexity meningiomas were investigated at least 3 years after surgery or until tumor recurrence to clarify risk factors for recurrence. Patients were restricted to Simpson Grade 1 resection only, and the authors excluded multiple meningiomas, neurofibromatosis, and atypical and anaplastic meningiomas. Correlation between recurrence and the following factors were statistically analyzed: age, gender, tumor volume, tumor shape, bone change, brain edema, vascular supply, histologic subtype, MIB-1 labeling index (LI), and VEGF expression.
Results:
Of the 54 patients with meningioma, 34 were positive (24: +1; 10: +2) for VEGF, and 20 were negative. Six (11.1%) meningiomas recurred during the follow-up period. Multivariate analysis revealed that high levels of expression of VEGF constituted the most useful predictor of recurrence (P = 0.005), followed by high MIB-1 LI (P = 0.039). The other factors were not significant. The tumor recurrence, when it occurred, was within the brain and not durally based.
Conclusions:
The current results suggest that high levels of VEGF expression are significantly related to the recurrence of meningioma. VEGF secretion from microscopic residue remaining after surgery may induce neovascularization, which promotes the recurrence of meningioma.
Insights
High vascular endothelial growth factor (VEGF) expression predicts recurrence in benign meningioma patients after surgery. This suggests VEGF promotes tumor regrowth through neovascularization, even after complete resection.
Area of Science:
- Neuro-oncology
- Surgical oncology
- Molecular biology
Background:
- Benign meningiomas can recur despite complete surgical removal.
- The precise mechanisms driving meningioma recurrence remain incompletely understood.
- Vascular endothelial growth factor (VEGF) is implicated in tumor neovascularization.
Purpose of the Study:
- To investigate if VEGF expression predicts recurrence in histologically benign meningiomas.
- To identify risk factors for meningioma recurrence after macroscopic total resection.
Main Methods:
- Analysis of 54 patients with supratentorial convexity meningiomas undergoing Simpson Grade 1 resection.
- Statistical correlation of recurrence with factors including age, gender, tumor characteristics, MIB-1 labeling index, and VEGF expression.
- Exclusion of patients with multiple meningiomas, neurofibromatosis, or atypical/anaplastic subtypes.
Main Results:
- Vascular endothelial growth factor (VEGF) expression was detected in 34 of 54 patients.
- Six meningiomas (11.1%) recurred during follow-up.
- High VEGF expression (P = 0.005) and high MIB-1 labeling index (P = 0.039) were significant predictors of recurrence.
Conclusions:
- Elevated VEGF expression is a significant indicator for meningioma recurrence.
- VEGF may promote recurrence by stimulating neovascularization from microscopic residual tumor cells.
- Targeting VEGF could be a potential strategy to prevent meningioma regrowth.