Integrated Molecular-Morphologic Meningioma Classification: A Multicenter Retrospective Analysis, Retrospectively and Prospectively Validated
Authors: Sybren L. N. Maas, Damian Stichel, Thomas Hielscher, Philipp Sievers, Anna S. Berghoff, Daniel Schrimpf, Martin Sill, Philipp Euskirchen, Christina Blume, Areeba Patel, Helin Dogan, David Reuss, Hildegard Dohmen, Marco Stein, Annekathrin Reinhardt, Abigail K. Suwala, Annika K. Wefers, Peter Baumgarten, Franz Ricklefs, Elisabeth J. Rushing, Melanie Bewerunge-Hudler, Ralf Ketter, Jens Schittenhelm, Zane Jaunmuktane, Severina Leu, Fay E. A. Greenway, Leslie R. Bridges, Timothy Jones, Conor Grady, Jonathan Serrano, John Golfinos, Chandra Sen, Christian Mawrin, Christine Jungk, Daniel Hänggi, Manfred Westphal, Katrin Lamszus, Nima Etminan, Gerhard Jungwirth, Christel Herold-Mende, Andreas Unterberg, Patrick N. Harter, Hans-Georg Wirsching, Marian C. Neidert, Miriam Ratliff, Michael Platten, Matija Snuderl, Kenneth D. Aldape, Sebastian Brandner, Jürgen Hench, Stephan Frank, Stefan M. Pfister, David T. W. Jones, Guido Reifenberger, Till Acker, Wolfgang Wick, Michael Weller, Matthias Preusser, Andreas von Deimling, Felix Sahm
Journal: Journal of Clinical Oncology (2021)

Meningiomas are the most frequent primary intracranial tumors. Patient outcome varies widely from benign to highly aggressive, ultimately fatal courses. Reliable identification of risk of progression for individual patients is of pivotal importance. However, only biomarkers for highly aggressive tumors are established (CDKN2A/B and TERT), whereas no molecularly based stratification exists for the broad spectrum of patients with low- and intermediate-risk meningioma.DNA methylation data and copy-number information were generated for 3,031 meningiomas (2,868 patients), and mutation data for 858 samples. DNA methylation subgroups, copy-number variations (CNVs), mutations, and WHO grading were analyzed. Prediction power for outcome was assessed in a retrospective cohort of 514 patients, validated on a retrospective cohort of 184, and on a prospective cohort of 287 multicenter cases.Both CNV- and methylation family-based subgrouping independently resulted in increased prediction accuracy of risk of recurrence compared with the WHO classification (c-indexes WHO 2016, CNV, and methylation family 0.699, 0.706, and 0.721, respectively). Merging all risk stratification approaches into an integrated molecular-morphologic score resulted in further substantial increase in accuracy (c-index 0.744). This integrated score consistently provided superior accuracy in all three cohorts, significantly outperforming WHO grading (c-index difference P = .005). Besides the overall stratification advantage, the integrated score separates more precisely for risk of progression at the diagnostically challenging interface of WHO grade 1 and grade 2 tumors (hazard ratio 4.34 [2.48-7.57] and 3.34 [1.28-8.72] retrospective and prospective validation cohorts, respectively).Merging these layers of histologic and molecular data into an integrated, three-tiered score significantly improves the precision in meningioma stratification. Implementation into diagnostic routine informs clinical decision making for patients with meningioma on the basis of robust outcome prediction.