title: The cytogenetic relationship between primary and recurrent meningiomas points to the need for new treatment strategies in cases at high risk of relapse.
abstract: OBJECTIVE
  Recurrence is the major factor influencing the clinical outcome of meningioma patients although the exact relationship between primary and recurrent tumors still needs to be clarified. The aim of the present study is to analyze the cytogenetic relationship between primary and subsequent recurrent meningiomas developed within the same individual.
  
  
  METHODS
  Multicolor interphase fluorescence in situ hybridization was done for the identification of numerical abnormalities of 12 chromosomes in single-cell suspensions from 59 tumor samples corresponding to 25 recurrent meningioma patients. In 47 of these tumors, the distribution of different tumor cell clones was also analyzed in paraffin-embedded tissue sections. In parallel, 132 nonrecurrent cases were also studied.
  
  
  RESULTS
  Most recurrent meningiomas showed complex cytogenetic aberrations associated with two or more tumor cell clones in the first tumor analyzed. Interestingly, in most individuals (74%), exactly the same tumor cell clones identified in the initial lesion were also detected in the subsequent recurrent tumor samples. In the recurrent tumor samples of the remaining cases (26%), we observed tumor cell clones related to those detected in the initial lesion but which had acquired one or more additional chromosome aberrations associated with either the emergence of new clones with more complex karyotypes or the disappearance of the most representative clones from the primary lesions. Multivariate analysis of prognostic factors showed that the Maillo et al. prognostic score, based on age of patient, tumor grade, and monosomy 14, together with tumor size was the best combination of independent variables for predicting tumor recurrence at diagnosis.
  
  
  CONCLUSIONS
  Overall, our results indicate that the development of recurrent meningiomas after complete tumor resection is usually due to regrowth of the primary tumor and rarely to the emergence of an unrelated meningioma, underlining the need for alternative treatment strategies in cases at high risk of relapse, particularly those with a high Maillo et al. prognostic score and larger tumors.
authors.affiliation: Unidad de Investigación, Neurosurgery Service, Hospital Universitario de Salamanca, University of Salamanca, Salamanca, Spain.
authors.forename: Ana Belén
authors.initials: AB
authors.lastname: Espinosa
authors.forename: María Dolores
authors.initials: MD
authors.lastname: Tabernero
authors.forename: Angel
authors.initials: A
authors.lastname: Maíllo
authors.forename: José María
authors.initials: JM
authors.lastname: Sayagués
authors.forename: Juana
authors.initials: J
authors.lastname: Ciudad
authors.forename: Marta
authors.initials: M
authors.lastname: Merino
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Alguero
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lubombo
authors.forename: Pablo
authors.initials: P
authors.lastname: Sousa
authors.forename: Angel
authors.initials: A
authors.lastname: Santos-Briz
authors.forename: Alberto
authors.initials: A
authors.lastname: Orfao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D045744:Cell Line, Tumor; D002869:Chromosome Aberrations; D003001:Cloning, Molecular; D018450:Disease Progression; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods*; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000628:therapy*; D008579:Meningioma / Q000175:diagnosis / Q000235:genetics* / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D016612:Paraffin Embedding; D012008:Recurrence; D012307:Risk Factors