title: Prognostic significance of the mitotic index using the mitosis marker anti-phosphohistone H3 in meningiomas.
abstract: Mitotic activity is one of the most reliable prognostic factors in meningiomas. The identification of mitotic figures (MFs) and the areas of highest mitotic activity in H&E-stained slides is a tedious and subjective task. Therefore, we compared the results from immunostaining for the mitosis-specific antibody anti-phosphohistone H3 (PHH3 mitotic index [MI]) with standard MF counts (H&E MI) and the Ki-67 labeling index (LI). The relationship between these proliferation indices and prognosis was investigated in a retrospective series of 265 meningiomas. The PHH3 staining method yielded greater sensitivity in the detection of MFs and facilitated MF counting. Mitotic thresholds of H&E MI of 4 or more per 10 high-power fields (HPF) and PHH3 MI of 6 or more per 10 HPF were found as the most appropriate prognostic cutoff values for the prediction of recurrence-free survival. All 3 proliferation indices were univariately associated with recurrences and deaths. In contrast with the Ki-67 LI, H&E MI and PHH3 MI also remained as independent predictors in the multivariate Cox hazards modeling (P = .0007 and P = .0004, respectively).
authors.affiliation: Institute of Neuropathology, Saarland University, School of Medicine, Homburg/Saar, Germany.
authors.forename: Yoo-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Ralf
authors.initials: R
authors.lastname: Ketter
authors.forename: Wolf-Ingo
authors.initials: WI
authors.lastname: Steudel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Feiden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006657:Histones / Q000032:analysis* / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology*; D008579:Meningioma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D008940:Mitotic Index; D010766:Phosphorylation; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D006657:Histones; D019394:Ki-67 Antigen