DNA topoisomerase II-alpha and cyclin A immunoexpression in meningiomas and its prognostic significance: an analysis of 263 cases.
ABSTRACT Routine pathologic examination cannot distinctively predict the clinical course of meningiomas because even histologically benign tumors may recur after gross total resection. Therefore, numerous efforts have been made to evaluate the meningioma growth fraction and its prognostic value. However, a universally applicable proliferative marker for meningioma outcome is not yet a reality.
To investigate the prognostic utility of 3 proliferative markers, namely, Ki-67, DNA topoisomerase II-alpha (topoII), and cyclin A in a representative series of intracranial meningiomas.
Two hundred sixty-three adult patients with intracranial meningiomas (208 benign, 42 atypical, and 13 anaplastic) were studied retrospectively. Tumor specimens were immunohistochemically examined with antibodies to Ki-67 (MM-1), topoII, and cyclin A. A computerized color image analyzer was used to count immunostained nuclei.
The topoII and cyclin A scores exhibited a close correlation with Ki-67 immunostaining. Significant differences between the indices for all 3 markers were noted among the 3 grades of meningiomas. The scores for all 3 markers were significantly different between recurrent and nonrecurrent meningiomas, including benign tumors that were treated with gross total resection. Recurrence-free survival was significantly reduced for cases with a Ki-67 labeling index (LI) of 4.4% or greater, a topoII LI of 3.2% or greater, and a cyclin A LI of 3.1% or greater. Multivariate analysis revealed that the risk of recurrence for the entire meningioma cohort was significantly associated with tumor grade (hazard ratio = 2.7; P =.004), topoII LI of 3.2% or greater (hazard ratio = 5.5; P <.001), and a cyclin A LI of 3.1% or greater (hazard ratio = 2.4; P =.01).
There is a close correlation in the expression of these 3 proliferative markers in meningiomas, and all of the markers showed a significant association with tumor grade, recurrence rate, and recurrence-free survival. Consequently, in addition to Ki-67, immunoexpression of topoII and cyclin A is available for predicting meningioma recurrence. Moreover, the topoII and cyclin A staining scores were found to be more sensitive predictors for meningioma progression than Ki-67 and, therefore, either of these 2 markers may prove to be clinically informative and useful.
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ABSTRACT: Meningiomas are common intracranial tumors, but relatively little is known about the genetic events responsible for their clinical diversity. Although recent genomic studies have provided clues, the genes identified often differ among publications. We used microarray expression profiling to identify genes that are differentially expressed, with at least a 4-fold change, between grade I and grade III meningiomas. We filtered this initial set of potential biomarkers through a second cohort of meningiomas and then verified the remaining genes by quantitative polymerase chain reaction followed by examination using a third microarray expression cohort. Using this approach, we identified 9 overexpressed (TPX2, RRM2, TOP2A, PI3, BIRC5, CDC2, NUSAP1, DLG7, SOX11) and 2 underexpressed (TIMP3, KCNMA1) genes in grade III versus grade I meningiomas. As a further validation step, we analyzed these genes in a fourth cohort and found that patients with grade II meningiomas with high topoisomerase 2-α protein expressions (>5% labeling index) had shorter times to death than patients with low expressions. We believe that this multistep multi-cohort approach provides a robust method for reducing false-positives while generating a list of reproducible candidate genes that are associated with clinically aggressive meningiomas and are suitable for analysis for their potential prognostic value.Journal of Neuropathology and Experimental Neurology 01/2011; 70(1):1-12. DOI:10.1097/NEN.0b013e3182018f1c · 4.37 Impact Factor
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ABSTRACT: Long follow-up studies show that the 10-year regrowth rate for grade I (benign) and II (atypical) meningiomas rises up to 15–25% and 30–35%, respectively, despite aggressive surgery. We investigated completely removed meningiomas grade I and II (n = 135) to identify and compare prognostic markers for tumour recurrence. We determined the immunohistochemical expression of 30 biomarkers, cell death assay by in situ hybridisation (ApopDETEKTM) and loss of chromosome 1p36 by FISH. The univariate statistical analysis showed that WHO grade, high cellularity, nuclear atypia, loss of 1p36 (determined in 20 out of 107 valid cases), expression of COX-2 (9 positive cases and 126 negative cases), Cyclin A, Topoisomerase IIα and MIB1/ki67 were associated with recurrence-free survival. The multivariate linkage analysis for the prognostic variables revealed that only 1p36 loss, expression of COX-2 and MIB1 were independent factors for predicting meningioma recurrence. The statistical analysis of COX-2 and 1p36 loss co-variation showed an antagonistic effect for both prognostic markers. Meningiomas with 1p36 loss showed significant increase of necrosis, nuclear atypia and increased expression of Cyclin E, PAKT, PDGF and p21. COX-2 overexpression was associated with increased VEGF, PDGF, HER2 and MDM2 expression. COX-2 inhibitors may be used as a putative chemopreventive treatment for meningioma recurrence in tumours with COX-2 over-expression.ResumenDiversos estudios con un largo periodo de seguimiento muestran que la tasa de recidiva para los meningiomas grado I (benignos) y II (atípicos) se sitúa entre el 15-25% y el 30-35% respectivamente, a pesar de una cirugía agresiva. Hemos investigado 135 meningiomas completamente resecados para identificar y comparar marcadores pronósticos de recurrencia tumoral. Hemos determinado la expresión inmunohistoquímica de 30 biomarcadores, la muerte celular por apoptosis mediante un ensayo de hibridación in situ (ApopDETEKTM) y las perdidas en el cromosoma 1p36 mediante FISH. El análisis estadístico univariante mostró que el grado tumoral de la OMS, la alta celularidad, la atipia nuclear, las pérdidas en el cromosoma 1p36 (determinadas en 20 de los 107 casos válidos) y la expresión de COX-2 (9 casos positivos y 126 negativos), Ciclina A, Topoisomerasa IIα y MIB1/Ki67 se asociaron con el periodo libre de recurrencia. El análisis multivariante de estas variables pronósticas reveló que solamente las pérdidas en el cromosoma 1p36 y la expresión de COX-2 y MIB1 eran factores independientes para la predicción de recidiva tumoral. El análisis estadístico para la covariación de COX-2 y las perdidas en 1p36 mostraron un efecto antagonista para ambos marcadores. Los meningiomas con pérdidas en 1p36 mostraron un incremento significativo de la necrosis, la atipia nuclear y la expresión de Ciclina E, PAKT, PDGF y p21. La sobreexpresión de COX-2 se asocia a su vez con un aumento de la expresión de VEGF, PDGF, HER2 y MDM2. Los inhibidores selectivos de COX-2 podrían ser usados como un tratamiento quimiopreventivo putativo para evitar la recurrencia en aquellos meningiomas con sobreexpresión de COX-2.01/2013; 46(1):14–25. DOI:10.1016/j.patol.2012.09.010
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ABSTRACT: Predicting which meningiomas will recur and which will not is clinically important, and still represents a major clinical challenge. A number of different molecular, genetic, and/or biochemical markers involved in cell proliferation, invasion, angiogenesis, and cell transformation have been investigated in attempts to predict the risk of post-surgical meningioma recurrence. In this short review we emphasize what has actually been accomplished in this area. Finally, we highlight the potential of S100 serum protein concentrations as a prognostic factor predicting meningioma recurrence. We conclude that serum concentrations of S100 group proteins may prove to be useful as prognostic markers and suggest further prospective trials be done.Clinical Chemistry and Laboratory Medicine 03/2011; 49(6):971-5. DOI:10.1515/CCLM.2011.157 · 2.96 Impact Factor