Mark W Youngblood1,2, Danielle F Miyagishima1,3,4, Lan Jin1, Trisha Gupte1,3, Chang Li1,5,6, Daniel Duran1,7, Julio D Montejo1,8, Amy Zhao1, Amar Sheth1, Evgeniya Tyrtova1,9, Koray Özduman10, Francesco Iacoangeli3,11, Matthieu Peyre11,12, Julien Boetto11, Matthew Pease11, Timuçin Avşar13, Anita Huttner1,14, Kaya Bilguvar1,15, Türker Kilic16, M Necmettin Pamir10, Nduka Amankulor12, Michel Kalamarides11, E Zeynep Erson-Omay1,3, Murat Günel1,3,15, Jennifer Moliterno1,3. 1. Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, Connecticut, USA. 2. Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA. 3. Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA. 4. Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA. 5. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China. 6. The Third Xiangya Hospital, Central South University, Changsha, China. 7. Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA. 8. Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire, USA. 9. Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA. 10. Department of Neurosurgery, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Turkey. 11. Department of Neurosurgery, Pitie-Salpetriere Hospital and Sorbonne University, Paris, France. 12. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 13. Department of Medical Biology, Bahçeşehir University (BAU) Faculty of Medicine, Istanbul, Turkey. 14. Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA. 15. Yale Center for Genome Analysis, Yale University West Campus, Orange, Connecticut, USA. 16. Department of Neurosurgery, BAU, School of Medicine, Istanbul, Turkey.
Abstract
BACKGROUND: We and others have identified mutually exclusive molecular subgroups of meningiomas; however, the implications of this classification for clinical prognostication remain unclear. Integrated genomic and epigenomic analyses implicate unique oncogenic processes associated with each subgroup, suggesting the potential for divergent clinical courses. The aim of this study was to understand the associated clinical outcomes of each subgroup, as this could optimize treatment for patients. METHODS: We analyzed outcome data for 469 meningiomas of known molecular subgroup, including extent of resection, postoperative radiation, surveillance imaging, and time to recurrence, when applicable. Statistical relationships between outcome variables and subgroup were assessed. Features previously associated with recurrence were further investigated after stratification by subgroup. We used Kaplan-Meier analyses to compare progression-free survival, and identified factors significantly associated with recurrence using Cox proportional hazards modeling. RESULTS: Meningioma molecular subgroups exhibited divergent clinical courses at 2 years of follow-up, with several aggressive subgroups (NF2, PI3K, HH, tumor necrosis factor receptor-associated factor 7 [TRAF7]) recurring at an average rate of 22 times higher than others (KLF4, POLR2A, SMARCB1). PI3K-activated tumors recurred earlier than other subgroups but had intermediate long-term outcome. Among low-grade tumors, HH and TRAF7 meningiomas exhibited elevated recurrence compared with other subgroups. Recurrence of NF2 tumors was associated with male sex, high grade, and elevated Ki-67. Multivariate analysis identified molecular subgroup as an independent predictor of recurrence, along with grade and previous recurrence. CONCLUSION: We describe distinct clinical outcomes and recurrence rates associated with meningioma molecular subgroups. Our findings emphasize the importance of genomic characterization to guide postoperative management decisions for meningiomas.
BACKGROUND: We and others have identified mutually exclusive molecular subgroups of meningiomas; however, the implications of this classification for clinical prognostication remain unclear. Integrated genomic and epigenomic analyses implicate unique oncogenic processes associated with each subgroup, suggesting the potential for divergent clinical courses. The aim of this study was to understand the associated clinical outcomes of each subgroup, as this could optimize treatment for patients. METHODS: We analyzed outcome data for 469 meningiomas of known molecular subgroup, including extent of resection, postoperative radiation, surveillance imaging, and time to recurrence, when applicable. Statistical relationships between outcome variables and subgroup were assessed. Features previously associated with recurrence were further investigated after stratification by subgroup. We used Kaplan-Meier analyses to compare progression-free survival, and identified factors significantly associated with recurrence using Cox proportional hazards modeling. RESULTS:Meningioma molecular subgroups exhibited divergent clinical courses at 2 years of follow-up, with several aggressive subgroups (NF2, PI3K, HH, tumor necrosis factor receptor-associated factor 7 [TRAF7]) recurring at an average rate of 22 times higher than others (KLF4, POLR2A, SMARCB1). PI3K-activated tumors recurred earlier than other subgroups but had intermediate long-term outcome. Among low-grade tumors, HH and TRAF7meningiomas exhibited elevated recurrence compared with other subgroups. Recurrence of NF2tumors was associated with male sex, high grade, and elevated Ki-67. Multivariate analysis identified molecular subgroup as an independent predictor of recurrence, along with grade and previous recurrence. CONCLUSION: We describe distinct clinical outcomes and recurrence rates associated with meningioma molecular subgroups. Our findings emphasize the importance of genomic characterization to guide postoperative management decisions for meningiomas.
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