Evaluation of prognostic biomarkers in meningiomas and their clinical implications in settings with limited resources.

BACKGROUND

The 5th edition of the World Health Organization (WHO) Central Nervous System (CNS) tumor classification for meningiomas acknowledges the clinical relevance of genomic profiling studies and emphasizes the importance of incorporating molecular information alongside histopathological features, leading to more accurate diagnoses and improved patient care.

METHODS

We analyzed 206 meningioma samples (108 histological grade 1, 89 grade 2, and 9 grade 3) to study mutations, homozygous deletion, loss of H3K27me3, and p16 expression. The association of these molecular markers with survival outcomes was also assessed.

RESULTS

mutation was found in 4.85% of cases, predominantly occurring in histological grade 2 (11.24%), while none of the histological grade 1 or 3 meningiomas exhibited this mutation. gene deletion was absent in grade 1 and detected in 2.24% of grade2, and 33.3% of histological grade 3 cases. There was a significant increase in loss of H3K27me3 with higher tumor grades, while p16 loss was observed in over 50% of cases across all histological grades. The presence of mutation and homozygous deletion resulted in the reclassification of 5.33% (11/206) of meningiomas as integrated grade 3. mutation and deletion, emerged as prognostically relevant markers, showing significant differences in progression-free survival (PFS) between integrated grade 3 and histological grade 2 meningiomas ( = .0002).

CONCLUSIONS

mutations are the most clinically relevant genetic alterations in meningiomas. Routine testing for mutations can identify high-risk cases of histologically grade 2 meningiomas, providing crucial prognostic information for treatment planning. alteration is rare and not cost-effective in assessing meningiomas. Immunohistochemical assessment of p16 and H3K27me3 expression lacks significant prognostic value. Assessment of mutations offers a cost-effective and valuable diagnostic tool for meningiomas.