Clinical and histopathological predictors of outcome in malignant meningioma

  • Andrea D. MaierEmail author
  • Jiri BartekJr
  • Frank Eriksson
  • Heidi Ugleholdt
  • Marianne Juhler
  • Helle Broholm
  • Tiit I. Mathiesen
Original Article


We investigated possible clinical and histopathological prognostic factors in a malignant meningioma cohort with comprehensive long-term population-based follow-up data. Twenty-four consecutive patients treated surgically for malignant meningioma at the Department of Neurosurgery and the Department of Pathology, Rigshospitalet, Copenhagen, Denmark, from December 2000 to March 2014 were retrospectively evaluated regarding progression-free survival (PFS) and overall survival (OS). Clinical parameters were recorded. All specimens underwent immunohistochemical analysis for Ki-67 and phosphohistone-H3 (PHH3). Prognostication was assessed with Cox proportional hazard regression analysis. The median follow-up was 46.1 months (range 0.7–150.7). The median progression-free survival was 16.5 months (95% CI 11.4–43.0) and the median overall survival was 46.6 months (95% CI 20.4–NA). Six patients were alive at the end of follow-up; two of these had not experienced a recurrence. No clinical parameter showed significant association with PFS or OS. Mitotic index (MI) was significantly associated with PFS and OS, and PHH3 MI with PFS. Immunohistochemical reactivity of Ki-67 > 10% was a negative predictor of PFS (HR 3.92, 95% CI 1.47–10.4, p = 0.0063) and OS (HR 3.35, 95% CI 1.12–10.1, p = 0.0313). The histological subgrouping of grade III meningioma into anaplastic and non-anaplastic revealed increased PFS for the latter (HR 4.57, CI 95% 1.32–15.7, p = 0.0164). We could not verify previous clinical parameters as prognostic factors in malignant meningioma. MI and the PHH3 MI were prognostic within WHO grade III meningiomas for PFS. An overall tumor staining of Ki-67 > 10% correlated with PFS and OS within grade III tumors.


Malignant meningioma Prognostic factors Ki-67 Phosphohistone-H3 



This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Danish Ethical Committee (approval number H-6-2014-010).

Informed consent

The ethical approval granted waiver of informed consent, as the project does not inflict any additional potential health risks to these patients, besides those which they already have been exposed to and are familiar with, in relation to the diagnostic and the therapeutic treatment. Patients who beforehand had denied the use of their leftover diagnostic material in research were not included, but there were no such requests among the cases of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Copenhagen University HospitalRigshospitaletCopenhagenDenmark
  2. 2.Department of NeurosurgeryKarolinska University HospitalStockholmSweden
  3. 3.Department of Clinical Neuroscience and Department of MedicineKarolinska InstitutetStockholmSweden
  4. 4.Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
  5. 5.Department of Pathology, Center of Diagnostic InvestigationCopenhagen University HospitalCopenhagenDenmark
  6. 6.Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark

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