title: Proposal for a new risk stratification classification for meningioma based on patient age, WHO tumor grade, size, localization, and karyotype.
abstract: BACKGROUND
  Tumor recurrence remains the major clinical complication of meningiomas, the majority of recurrences occurring among WHO grade I/benign tumors. In the present study, we propose a new scoring system for the prognostic stratification of meningioma patients based on analysis of a large series of meningiomas followed for a median of >5 years.
  
  
  METHODS
  Tumor cytogenetics were systematically investigated by interphase fluorescence in situ hybridization in 302 meningioma samples, and the proposed classification was further validated in an independent series of cases (n = 132) analyzed by high-density (500K) single-nucleotide polymorphism (SNP) arrays.
  
  
  RESULTS
  Overall, we found an adverse impact on patient relapse-free survival (RFS) for males, presence of brain edema, younger patients (<55 years), tumor size >50 mm, tumor localization at intraventricular and anterior cranial base areas, WHO grade II/III meningiomas, and complex karyotypes; the latter 5 variables showed an independent predictive value in multivariate analysis. Based on these parameters, a prognostic score was established for each individual case, and patients were stratified into 4 risk categories with significantly different (P < .001) outcomes. These included a good prognosis group, consisting of approximately 20% of cases, that showed a RFS of 100% ± 0% at 10 years and a very poor-prognosis group with a RFS rate of 0% ± 0% at 10 years. The prognostic impact of the scoring system proposed here was also retained when WHO grade I cases were considered separately (P < .001).
  
  
  CONCLUSIONS
  Based on this risk-stratification classification, different strategies may be adopted for follow-up, and eventually also for treatment, of meningioma patients at different risks for relapse.
authors.affiliation: Center for Neurosciences and Cell Biology, and Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal (P.H.D., C.d.O., M.C.L.); Center for Cancer Research (CIC-IBMCC; CSIC/USAL) and Department of Medicine, University of Salamanca, Salamanca, Spain (P.H.D., A.O*., M.D.T.); Neurosurgery Service, University Hospital of Salamanca, Salamanca, Spain (P.S., A.O., J.M.G., L.R.); Research Unity and IECSCYL, University Hospital of Salamanca IBSAL, Salamanca, Spain (M.D.T.).
authors.forename: Patrícia Henriques
authors.initials: PH
authors.lastname: Domingues
authors.forename: Pablo
authors.initials: P
authors.lastname: Sousa
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Otero
authors.forename: Jesus Maria
authors.initials: JM
authors.lastname: Gonçalves
authors.forename: Laura
authors.initials: L
authors.lastname: Ruiz
authors.forename: Catarina
authors.initials: C
authors.lastname: de Oliveira
authors.forename: Maria Celeste
authors.initials: MC
authors.lastname: Lopes
authors.forename: Alberto
authors.initials: A
authors.lastname: Orfao
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Tabernero
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology; D002648:Child; D020732:Cytogenetic Analysis; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007621:Karyotyping; D008297:Male; D008579:Meningioma / Q000175:diagnosis* / Q000235:genetics* / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: SNP arrays; iFISH; meningioma; recurrence; risk stratification