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Updated: Aug 29, 2026
Evaluation of Biomarkers in Glioma by Immunohistochemistry on Paraffin-Embedded 3D Glioma Neurosphere Cultures
Published on: January 9, 2019
The combination of mitotic and Ki-67 indices as a useful method for predicting short-term recurrence of meningiomas
Jun A Takahashi1, Tetsuya Ueba, Nobuo Hashimoto
1Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Background:
The most relevant factor in the progression-free survival (PFS) of patients with meningiomas is the malignant grade. However, using only the current World Health Organization (WHO) definition that does not consider precise quantitative indicators, an unequivocal diagnosis of the malignant grade is difficult. In our retrospective study of the PFS of meningioma patients, we focused on mitoses and the Ki-67 staining index of tumor specimens obtained at the initial surgery.
Methods And Results:
A total of 349 patients with intracranial meningioma, operated between 1978 and 2000, were followed for a mean of 7 years. According to the mitotic index (MI), we classified them into 3 groups. In Group A (n = 326), slide-mounted tumor samples exhibited no mitoses; in Group B (n = 15) there were fewer than 4 mitoses, and in Group C (n = 8) 4 or more mitoses were seen per 10 high-power fields (HPF). The estimated 5-year PFS rates in Groups A, B, and C were 93%, 10%, and 13% respectively. The mean PFS for Group A was 148 months; in Groups B and C the median PFS was 43 and 16 months, respectively. A Ki-67 staining index (SI) of less than 1% corresponded with no mitosis, while an SI exceeding 5% was indicative of the presence of mitoses.
Conclusion:
In meningioma patients, no mitoses and/or a Ki-67 SI <1% signals a favorable outcome. An SI >5% or the presence of mitoses, even fewer than 4 in 10 HPF, is suggestive of a short PFS irrespective of other pathologic features. We suggest that in combination, assay of the Ki-67 SI and the MI represents a reliable, quantitative tool for predicting PFS in meningioma patients.
Insights
Meningioma patients with no mitoses or low Ki-67 staining index (<1%) have a favorable prognosis. High Ki-67 ( >5%) or any mitoses indicate shorter progression-free survival (PFS).
Area of Science:
- Neuro-oncology
- Pathology
- Surgical Oncology
Background:
- Meningioma progression-free survival (PFS) is linked to malignant grade.
- Current World Health Organization (WHO) grading lacks precise quantitative indicators.
- Accurate grading is crucial for predicting meningioma patient outcomes.
Purpose of the Study:
- To evaluate the prognostic value of mitotic index (MI) and Ki-67 staining index (SI) in meningioma patients.
- To establish quantitative tools for predicting PFS in meningiomas.
- To improve the diagnostic accuracy of meningioma grading.
Main Methods:
- Retrospective analysis of 349 intracranial meningioma patients operated between 1978 and 2000.
- Classification into three groups based on mitotic index (MI): Group A (no mitoses), Group B (<4 mitoses/10 HPF), Group C (≥4 mitoses/10 HPF).
- Correlation of MI and Ki-67 staining index (SI) with progression-free survival (PFS).
Main Results:
- Five-year PFS rates were 93% (Group A), 10% (Group B), and 13% (Group C).
- Mean PFS was 148 months (Group A), with median PFS of 43 months (Group B) and 16 months (Group C).
- Ki-67 SI <1% correlated with no mitoses; SI >5% indicated the presence of mitoses.
Conclusions:
- No mitoses and/or Ki-67 SI <1% predict a favorable outcome for meningioma patients.
- Ki-67 SI >5% or presence of mitoses suggests short PFS, regardless of other features.
- Combined MI and Ki-67 SI assay offers a reliable, quantitative method for predicting meningioma PFS.
