title: Spheno-Orbital Meningiomas: An Analysis Based on World Health Organization Classification and Ki-67 Proliferative Index.
abstract: To evaluate the clinical behavior of spheno-orbital meningiomas with regard to World Health Organization (WHO) tumor grade and Ki-67, a cellular marker of proliferation.
  
  
  
  A retrospective review over a 16-year period of the demographic, clinical, radiographic, and surgical data of all patients with spheno-orbital meningioma who underwent surgical resection. Tumor specimens were examined histologically using the current WHO 2016 classification and immunohistochemically using Ki-67/MIB-1 monoclonal antibody.
  
  
  
  Thirty-eight patients met all inclusion criteria: 78.9% of tumors were WHO grade I with a mean Ki-67 of 3.76, and 93% of patients were clinically stable at last follow up; 10.5% of lesions were WHO grade II (atypical) with a mean Ki-67 of 14.93, and 10.5% of lesions were WHO grade III (anaplastic) with a mean Ki-67 of 58.3. All grade II and III meningiomas exhibited an aggressive clinical course. There were statistically significant correlations between disease clinical progression and WHO tumor grade (p < 0.001), between disease clinical progression and Ki-67 (p < 0.001), and between increasing Ki-67 index and higher WHO grade (p < 0.001). For WHO grade I lesions, a Ki-67 of ≥3.3 correlated with recurrence (p = 0.0256). Overall, disease-specific mortality occurred in 5 (13%) patients.
  
  
  
  Ki-67 index is a valuable marker to use in conjunction with WHO grade to predict meningioma behavior, particularly in histologically borderline lesions, and possibly to identify a subset of WHO grade I tumors at risk of recurrence. This combination of methods can aid in tailoring treatment and surveillance strategies.
authors.forename: Irina
authors.initials: I
authors.lastname: Belinsky
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Ann P
authors.initials: AP
authors.lastname: Murchison
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: James J
authors.initials: JJ
authors.lastname: Evans
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: David W
authors.initials: DW
authors.lastname: Andrews
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Farrell
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: James P
authors.initials: JP
authors.lastname: Casey
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Curtis
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Kamila A
authors.initials: KA
authors.lastname: Nowak Choi
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Maria
authors.initials: M
authors.lastname: Werner-Wasik
authors.affiliation: Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Jurij R
authors.initials: JR
authors.lastname: Bilyk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000378:metabolism; D000911:Antibodies, Monoclonal / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism*; D008297:Male; D008579:Meningioma / Q000145:classification / Q000378:metabolism / Q000473:pathology; D008875:Middle Aged; D009918:Orbital Neoplasms / Q000145:classification / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D013100:Sphenoid Bone; D014944:World Health Organization
chemical_list: D000974:Antibodies, Antinuclear; D000911:Antibodies, Monoclonal; D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; C440408:MIB-1 antibody