Association between absence of epidermal growth factor receptor immunoreactivity and poor prognosis in patients with atypical meningioma.
OBJECTIVE
The clinical behavior of meningiomas is variable. Because multiple growth factor receptors have been identified in these tumors, the authors sought to assess the capacity of the expression patterns of a subset of these receptors to stratify meningioma cases.


METHODS
Eighty-four meningiomas were analyzed, including 36 benign, 29 atypical, and 19 malignant lesions. Immunohistochemical staining was performed for epidermal growth factor receptor (EGFR), platelet-derived growth factor receptor (PDGFR)-beta, basic fibroblast growth factor receptor (BFGFR), and MIB-1. Survival analyses were performed using follow-up data obtained in patients with newly diagnosed tumors. Immunoreactivity for EGFR was observed in 47% of benign, 48% of atypical, and 42% of malignant tumors. Staining for BFGFR was identified in 89% of benign, 97% of atypical, and 95% of malignant lesions. Immunostaining for PDGFR-beta was evident in all the lesions assessed. Mean MIB-I indices for benign, atypical, and malignant cases were 3.6 (range 0.5-15.3), 8.2 (range 1.5-23.1) and 18.3 (range 1.0-55.8), respectively. Overall mean follow-up duration was 9.0 years (range 5.1-18.8 years). Lack of EGFR immunoreactivity was identified as a strong predictor of shorter overall survival in patients with atypical meningioma (p = 0.003, log-rank test). This association was not evident in cases of benign or malignant meningiomas.


CONCLUSIONS
There is a significant association between EGFR immunoreactivity and prolonged survival in patients with atypical meningioma. Given the variable behavior of atypical meningiomas, EGFR assessment could improve existing strategies for patient stratification and treatment.
Smith
Justin S
JS
Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco, California 94143-0112, USA. jsmith1enator@gmail.com
Lal
Anita
A
Harmon-Smith
Miranda
M
Bollen
Andrew W
AW
McDermott
Michael W
MW
D066246:ErbB Receptors / Q000378:metabolism*; D005260:Female; D016222:Fibroblast Growth Factor 2 / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008577:Meningeal Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D008579:Meningioma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D008940:Mitotic Index; D011379:Prognosis; D020574:Proto-Oncogene Proteins c-sis / Q000096:biosynthesis; D017468:Receptors, Fibroblast Growth Factor / Q000378:metabolism; D016019:Survival Analysis; D016707:Tissue Fixation
D019394:Ki-67 Antigen; D020574:Proto-Oncogene Proteins c-sis; D017468:Receptors, Fibroblast Growth Factor; D016222:Fibroblast Growth Factor 2; D066246:ErbB Receptors