The Ki-67 proliferation index and recurrence risk of intracranial meningioma: a multicenter, retrospective cohort study of 5,050 patients

PURPOSE: The Ki-67 proliferation index (Ki-67 PI) has been associated with meningioma recurrence, yet its clinical utility remains debated. Whether Ki-67 PI provides prognostic information across subgroups defined by both WHO grade and extent of resection remains to be investigated. METHODS: We analyzed 5,050 patients with intracranial meningiomas from the international PERNS cohort (42 centers, diagnosed between 1989-2019) who underwent surgical resection without postoperative radiotherapy. Ki-67 PI prognostic accuracy was assessed up to 10 years postoperatively by using ROC analyses and estimating its association with the risk of recurrence. RESULTS: Results demonstrated that the prognostic value of Ki-67 PI differed by subgroups defined by WHO grade and Simpson grade. For patients with the same Simpson grade (1-3), the predictive accuracy of Ki-67 PI for 10-year recurrence risk was stronger in WHO-2 than in WHO-1. Within WHO-1 and WHO-2 meningiomas, the predictive accuracy of Ki-67 PI increased with higher Simpson grade (1-3). However, no predictive value was observed in Simpson grade 4 resections regardless of WHO grade. CONCLUSION: These findings highlight that Ki-67 PI should be interpreted in the context of both WHO grade and extent of resection, and, if done so, may offer potential value to refine individualized surveillance strategies in meningioma patients with gross total resection in the initial 10-year postoperative timeframe. Findings cannot be extrapolated beyond 10 years, which may be particularly relevant for WHO-1 tumors with low Ki-67 PI and Simpson grade 1 resection.

Authors

Institutions

Publication Details

Journal
Acta Neurochirurgica
Published
2026-04-06
DOI
https://doi.org/10.1007/s00701-026-06846-y
Primary Topic
Meningioma and schwannoma management
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

The Ki-67 proliferation index and recurrence risk of intracranial meningioma: a multicenter, retrospective cohort study of 5,050 patients

Soichi Oya, Tamás Csonka, Matthew Koshy, Jennifer Moliterno et al.
Acta Neurochirurgica
Meningioma and schwannoma management
article

The Ki-67 proliferation index and recurrence risk of intracranial meningioma: a multicenter, retrospective cohort study of 5,050 patients

Soichi Oya, Tamás Csonka, Matthew Koshy, Jennifer Moliterno, Tony Catalan, Tiit Illimar Mathiesen, John Ta-Hsiang Tsiang, Yasuhiro Kuroi, Dorothee Cäcilia Spille, Tina Nørgaard Munch, Pedro Góes, Vikram C. Prabhu, Bjarne Winther Kristensen, Aria Jamshidi, Luís Souhami, Luca Bertero, Konstantinos Gousias, Dennis C. Shrieve, Donald M. Cannon, Paul Blanche, Benjamin Brokinkel, Tabernero, Philip V. Theodosopoulos, Andrea Daniela Maier, Simon Skyrman, Maria Kamenova, Lasse Rehné Jensen, Sven Straumann, Tareq Adnan Juratli, Christian Mirian, Francesco Maiuri, Kåre Fugleholm, Austin Lui, Torstein Ragnar Meling, Stéphane Goutagny, Anders Broechner, Chang-Ok Suh, Ilker Y. Eyüpoglu, Olivia Claire Barrett, Ian Law, Nobuhito Saito, Jong Hee Chang, Daniel W. Kim, Randy Jensen, Johannes Wach, Jacob S. Young, Akash J. Patel, David Scheie, Jehuda Soleman, Tejpal Gupta, Michael Ivan, Sverre H. Torp, Fang Wang, Martin Proescholdt, Young Zoon Kim, Stephen T. Magill, Matthias Simon, Ricardo Komotar, Jun Won Kim, Joo Ho Lee, Toshiki Endo, Karthikeyan Perumal, Michael W. McDermott, Mustafa K. Baskaya, Tiemo J. Klisch, Marie-Christine Guiot, Evan Luther, Helen A. Shih, Ramin A. Morshed, Erdem Güresir, Junkoh Yamamoto, Ricardo Prat-Acin, Satoru Miyawaki, Valeria Barresi, Walter Stummer
article en

Abstract

PURPOSE: The Ki-67 proliferation index (Ki-67 PI) has been associated with meningioma recurrence, yet its clinical utility remains debated. Whether Ki-67 PI provides prognostic information across subgroups defined by both WHO grade and extent of resection remains to be investigated. METHODS: We analyzed 5,050 patients with intracranial meningiomas from the international PERNS cohort (42 centers, diagnosed between 1989-2019) who underwent surgical resection without postoperative radiotherapy. Ki-67 PI prognostic accuracy was assessed up to 10 years postoperatively by using ROC analyses and estimating its association with the risk of recurrence. RESULTS: Results demonstrated that the prognostic value of Ki-67 PI differed by subgroups defined by WHO grade and Simpson grade. For patients with the same Simpson grade (1-3), the predictive accuracy of Ki-67 PI for 10-year recurrence risk was stronger in WHO-2 than in WHO-1. Within WHO-1 and WHO-2 meningiomas, the predictive accuracy of Ki-67 PI increased with higher Simpson grade (1-3). However, no predictive value was observed in Simpson grade 4 resections regardless of WHO grade. CONCLUSION: These findings highlight that Ki-67 PI should be interpreted in the context of both WHO grade and extent of resection, and, if done so, may offer potential value to refine individualized surveillance strategies in meningioma patients with gross total resection in the initial 10-year postoperative timeframe. Findings cannot be extrapolated beyond 10 years, which may be particularly relevant for WHO-1 tumors with low Ki-67 PI and Simpson grade 1 resection.

Acta Neurochirurgica
Statens Serum Institut (DK), Northwestern University (US), University of Verona (IT), University of Copenhagen (DK), Loyola University Medical Center (US), University of Debrecen (HU), University of Wisconsin–Madison (US), Harvard University (US), Seoul National University (KR), University of California, San Francisco (US), Baylor College of Medicine (US), University of Occupational and Environmental Health Japan (JP), Yonsei University (KR), European University Cyprus (CY), Université Paris Cité (FR), Norwegian University of Science and Technology (NO), University of Utah (US), University of Münster (DE), Samsung (South Korea) (KR), Hôpital Beaujon (FR), Tata Memorial Hospital (IN), Allegheny General Hospital (US), Huntsman Cancer Institute (US), McGill University Health Centre (CA), University Hospital of Basel (CH), Copenhagen University Hospital (DK), Rigshospitalet (DK), Seoul National University Hospital (KR), Karolinska Institutet (SE), University Hospital Regensburg (DE), University of Illinois Chicago (US), Massachusetts General Hospital (US), Assistance Publique – Hôpitaux de Paris (FR), Center for Neuro-Oncology (US), St Olav's University Hospital (NO), University of Tokyo Hospital (JP), Neurological Research Institute (US), Leitat Technological Center (ES), Mobile Infirmary (US), University of Illinois Hospital & Health Sciences System (US), University Hospital Leipzig (DE), Athens Medical Center (GR), Clemenshospital Münster (DE), Instituto de Investigación Biomédica de Salamanca (ES), Tokyo Women's Medical University Adachi Medical Center (JP), Gangnam Severance Hospital (KR), Texas Children's Hospital (US), Hackensack Meridian Health (US), Center for Cancer Research (US), First Affiliated Hospital of Zhengzhou University (CN), Sylvester Comprehensive Cancer Center (US), Advanced Centre for Treatment, Research and Education in Cancer (IN), Neurological Surgery (US), Social Insurance Saitama Chuo Hospital (JP), University Hospital Carl Gustav Carus (DE), Fondazione IRCCS Istituto Neurologico Carlo Besta (IT), Smilow Cancer Hospital (US), University of Naples Federico II (IT), Technische Universität Dresden (DE), Sungkyunkwan University (KR), Tohoku Medical and Pharmaceutical University (JP), Saitama Medical University (JP), Universidade Federal de São Paulo (BR)
Cancer Prevention and Research Institute of Texas, Københavns Universitet, Lundbeckfonden
Openalex Percentile: Top 28%
Meningioma and schwannoma management
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.