PROGESTERONE AND ESTROGEN-RECEPTORS IN MENINGIOMAS - PROGNOSTIC CONSIDERATIONS

Meningiomas often contain steroid hormone receptors, but the correlati on of receptor presence with patient outcome or mitotic index is uncle ar. Intracranial meningiomas from 70 patients (27 males and 43 females , mean age 52.9 + 1.7 years [mean +/- standard error of the mean], ran ge 15-78 years) were evaluated immunocytochemically for female sex hor mone receptors using specific monoclonal antibodies. Prognostic correl ations were determined using statistical analyses that included clinic al and histological variables. Twenty-eight tumors were benign, 27 had atypical features, and 15 were malignant. Thirty tumors were meningot heliomatous, 11 were fibroblastic, 28 were transitional, and one was s ecretory. Twenty-nine of the 70 primary tumors recurred (mean interval to recurrence 50.1 +/- 10 months). The mean progression-free follow-u p period for patients without recurrence was 82.1 +/- 7.7 months. Nucl ear staining for the progesterone receptor (PR) was found in 58 cases (83%) and PR status was scored as 0 (0% nuclei positive), 1 (< 1%), 2 (1-9%), 3 (10-49%), or 4 (> 50%). Only six tumors (8.6%) contained nuc lear estrogen receptor (ER) staining, which was limited to a small num ber of nuclei (< 1%). Fisher's exact test (two-tailed) showed an inver se correlation between tumor grade and PR staining score (p less than or equal to 0.001), with 96% of benign and 40% of malignant meningioma s containing PR-positive nuclei. No correlation between age or histolo gical subtype and PR score was detected. Meningiomas from female patie nts had more PRs (p less than or equal to 0.05). Analysis of variance revealed that the mitotic index (total counts of mitoses per 10 high-p ower fields) for tumors with 0 PR staining (18 +/- 4.4) was higher (p less than or equal to 0.0001) than for those with PR scores of 1 to 4 (4.3 +/- 1.9, 5.1 +/- 2, 2.2 +/- 0.8, and 1.7 +/- 0.9, respectively). Univariate analysis indicated that the absence of PR, high mitotic ind ex, and higher tumor grade were significant factors for shorter diseas e-free intervals. Multivariate analysis showed that a three-factor int eraction model, with a PR score of 0, mitotic index greater than 6, an d malignant tumor grade, was a highly significant predictor (p < 0.000 1) for worse outcome in patients harboring meningiomas. These data ind icate that the presence of PRs, even in a small number of tumor cells, is a favorable prognostic factor for meningiomas.