INSERM U1256, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy.
Department of Pathology, CHRU, Nancy, France.
J Neuropathol Exp Neurol. 2020 Jul 1;79(7):754-762. doi: 10.1093/jnen/nlaa038.
The diagnosis of anaplastic meningioma (AM) (WHO grade III) is based on the presence of a high mitotic index (MI) and/or overt anaplasia. Only few data exist about the reproducibility and prognostic value of overt anaplasia. Additionally, the prognostic value of H3K27me3 loss in AM has not yet been demonstrated. Our objectives were to evaluate the reproducibility and prognostic value of WHO criteria and H3K27me3 loss in a multicenter series of 66 AM. Interobserver reproducibility was good for the determination of WHO grade (Kappa = 0.671) and MI (intraclass correlation coefficient [ICC] = 0.649), and fair for assessment of overt anaplasia (Kappa = 0.366). Patients with meningiomas showing high MI had significantly shorter overall survival (OS) than patients with meningiomas showing overt anaplasia without high MI (p = 0.009). OS was significantly lower in case of overt anaplasia with low MI (<20/1.6 mm2) than in atypical meningiomas (p = 0.008). H3K27me3 loss was present in 10/47 (21%) of AM and independently associated with shorter OS (p = 0.036; Cox multivariate analysis), with a good reproducibility (Kappa = 0.643). In conclusion, the presence of overt anaplasia could give additional prognostic information in tumors lacking high MI. Finally, loss of H3K27me3 is an easy-to-use and reproducible marker of poorer prognosis.
间变性脑膜瘤（AM）（WHO 分级 III）的诊断基于存在高有丝分裂指数（MI）和/或明显间变。关于明显间变的可重复性和预后价值仅有很少的数据。此外，H3K27me3 缺失在 AM 中的预后价值尚未得到证实。我们的目的是在 66 例 AM 的多中心系列中评估 WHO 标准和 H3K27me3 缺失的可重复性和预后价值。确定 WHO 分级（Kappa = 0.671）和 MI（组内相关系数 [ICC] = 0.649）的观察者间可重复性良好，评估明显间变的可重复性为一般（Kappa = 0.366）。具有高 MI 的脑膜瘤患者的总生存期（OS）明显短于具有高 MI 但无明显间变的脑膜瘤患者（p = 0.009）。具有低 MI（<20/1.6 mm2）的明显间变的 OS 明显低于非典型脑膜瘤（p = 0.008）。在 47 例 AM 中有 10 例（21%）存在 H3K27me3 缺失，与较短的 OS 独立相关（p = 0.036；Cox 多变量分析），具有良好的可重复性（Kappa = 0.643）。总之，在缺乏高 MI 的肿瘤中，明显间变的存在可能提供额外的预后信息。最后，H3K27me3 的缺失是预后较差的一种易于使用和可重复的标志物。
