Meningiomas are the most common primary intracranial tumors in adults. Although benign in a majority of cases, they have a variable clinical course and may recur even after a thorough surgical resection. Ki-67, a nuclear protein involved in cell cycle regulation, has been widely studied as a marker of cellular proliferation in various cancers. However, the prognostic significance of Ki-67 in meningiomas remains controversial. Here, we investigate the Ki-67 index, as a predictive marker of meningioma recurrence following surgical resection and compare it to established prognostic markers such as WHO grade and degree of resection. The medical records of 451 patients with previously untreated cranial meningiomas who underwent resections from January 2011 to January 2021 at North Shore University Hospital (NSUH) were reviewed. Collected data included WHO grade, Ki-67 proliferative index, degree of resection — gross (GTR) vs subtotal (STR) — as judged by the surgeon, tumor location, and meningioma recurrence. This study was approved by the NSUH Institutional Review Board IRB 21-1107. There were 290 patients with grade I, 154 with grade II, and 7 with grade III meningiomas. The average post-resection follow-up period was 4 years, and 82 tumors (18 %) recurred. Higher WHO grades were associated with higher rates of recurrence, with rates of 11.4 %, 27.9 %, and 71.4 % for grades 1, 2, and 3, respectively, and subtotal resection corresponded to a higher rate of recurrence than total resection (34.3 % and 13.4 %, respectively). Higher WHO grades also correlated with higher Ki-67 scores (2.59, 10.01, and 20.71) for grades 1, 2, and 3, respectively. A multivariate logistic regression model identified Ki-67 and degree of resection as independent predictive variables for meningioma recurrence, with Ki-67 specifically predicting recurrence in the WHO grade II subset when analyzed separately for WHO grades I and II. Our 10-year retrospective study suggests that the Ki-67 index is an important predictive marker for recurrence of intracranial meningiomas following surgical resection, particularly among patients with WHO grade II tumors. Our findings add to a growing body of data that support inclusion of Ki-67 index in the WHO grading criteria for patients with meningiomas.

中文翻译：

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Ki-67 指数作为手术切除后脑膜瘤复发的预测标志物

脑膜瘤是成人最常见的原发性颅内肿瘤。尽管大多数病例是良性的，但它们的临床病程各不相同，即使在彻底的手术切除后也可能复发。 Ki-67 是一种参与细胞周期调节的核蛋白，作为各种癌症细胞增殖的标志物已被广泛研究。然而，Ki-67 在脑膜瘤中的预后意义仍存在争议。在这里，我们研究了 Ki-67 指数，作为手术切除后脑膜瘤复发的预测标志物，并将其与已建立的预后标志物（例如 WHO 分级和切除程度）进行比较。对 2011 年 1 月至 2021 年 1 月在北岸大学医院 (NSUH) 接受切除术的 451 名先前未经治疗的颅脑膜瘤患者的医疗记录进行了审查。收集的数据包括 WHO 分级、Ki-67 增殖指数、外科医生判断的切除程度（大体切除 (GTR) 与次全切除 (STR)）、肿瘤位置和脑膜瘤复发情况。这项研究得到了 NSUH 机构审查委员会 IRB 21-1107 的批准。其中 I 级脑膜瘤 290 例，II 级 154 例，III 级脑膜瘤 7 例。切除后平均随访时间为 4 年，82 个肿瘤（18%）复发。 WHO 分级越高，复发率越高，1、2、3 级的复发率分别为 11.4%、27.9% 和 71.4%，次全切除的复发率高于全切除（34.3%）。和 13.4%）。较高的 WHO 等级还与 1、2 和 3 级的较高 Ki-67 分数（分别为 2.59、10.01 和 20.71）相关。多变量逻辑回归模型将 Ki-67 和切除程度确定为脑膜瘤复发的独立预测变量，当分别对 WHO I 级和 II 级进行分析时，Ki-67 特别预测 WHO II 级子集中的复发。我们的 10 年回顾性研究表明，Ki-67 指数是手术切除后颅内脑膜瘤复发的重要预测标志物，特别是在 WHO II 级肿瘤患者中。我们的研究结果丰富了越来越多的数据，支持将 Ki-67 指数纳入 WHO 脑膜瘤患者分级标准。