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

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

doi:10.1007/s00701-026-06846-y

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

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

^*Corresponding author af dette arbejde

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.

Originalsprog	Engelsk
Tidsskrift	Acta Neurochirurgica
ISSN	0001-6268
DOI	https://doi.org/10.1007/s00701-026-06846-y
Status	E-pub ahead of print - 6 apr. 2026

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10.1007/s00701-026-06846-yLicens: CC BY

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Mirian, C., Jensen, L. R., Juratli, T. A., Maier, A. D., Broechner, A., Torp, S. H., Shih, H. A., Morshed, R. A., Young, J. S., Magill, S. T., Bertero, L., Stummer, W., Spille, D. C., Brokinkel, B., Oya, S., Miyawaki, S., Saito, N., Proescholdt, M., Kuroi, Y., ... Mathiesen, T. (2026). The Ki-67 proliferation index and recurrence risk of intracranial meningioma: a multicenter, retrospective cohort study of 5,050 patients. Acta Neurochirurgica. Advance online publication. https://doi.org/10.1007/s00701-026-06846-y

Mirian, C, Jensen, LR, Juratli, TA, Maier, AD , Broechner, A, Torp, SH, Shih, HA, Morshed, RA, Young, JS, Magill, ST, Bertero, L, Stummer, W, Spille, DC, Brokinkel, B, Oya, S, Miyawaki, S, Saito, N, Proescholdt, M, Kuroi, Y, Gousias, K, Simon, M, Moliterno, J, Prat-Acin, R, Goutagny, S, Prabhu, VC, Tsiang, JT, Wach, J, Güresir, E, Yamamoto, J, Kim, YZ, Lee, JH, Kim, DW, Koshy, M, Perumal, K, Baskaya, MK, Cannon, DM, Shrieve, DC, Suh, C-O, Chang, JH, Kamenova, M, Straumann, S, Soleman, J, Eyüpoglu, IY, Catalan, T, Lui, A, Theodosopoulos, PV, McDermott, MW, Wang, F, Góes, P, Jamshidi, A, Komotar, R, Ivan, M, Luther, E, Souhami, L, Guiot, M-C, Csonka, T, Endo, T, Barrett, OC, Jensen, R, Gupta, T, Patel, AJ, Klisch, TJ, Kim, JW, Maiuri, F, Barresi, V, Tabernero, MD, Skyrman, S, Law, I , Scheie, D , Kristensen, BW , Munch, TN , Meling, T , Fugleholm, K, Blanche, P & Mathiesen, T 2026, 'The Ki-67 proliferation index and recurrence risk of intracranial meningioma: a multicenter, retrospective cohort study of 5,050 patients', Acta Neurochirurgica. https://doi.org/10.1007/s00701-026-06846-y

@article{5ffffa6e54de40adbccb1caf7fc03582,

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

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.",

author = "Christian Mirian and Jensen, \{Lasse Rehn{\'e}\} and Juratli, \{Tareq A\} and Maier, \{Andrea Daniela\} and Anders Broechner and Torp, \{Sverre H\} and Shih, \{Helen A\} and Morshed, \{Ramin A\} and Young, \{Jacob S\} and Magill, \{Stephen T\} and Luca Bertero and Walter Stummer and Spille, \{Dorothee C{\"a}cilia\} and Benjamin Brokinkel and Soichi Oya and Satoru Miyawaki and Nobuhito Saito and Martin Proescholdt and Yasuhiro Kuroi and Konstantinos Gousias and Matthias Simon and Jennifer Moliterno and Ricardo Prat-Acin and St{\'e}phane Goutagny and Prabhu, \{Vikram C\} and Tsiang, \{John T\} and Johannes Wach and Erdem G{\"u}resir and Junkoh Yamamoto and Kim, \{Young Zoon\} and Lee, \{Joo Ho\} and Kim, \{Daniel W\} and Matthew Koshy and Karthikeyan Perumal and Baskaya, \{Mustafa K\} and Cannon, \{Donald M\} and Shrieve, \{Dennis C\} and Chang-Ok Suh and Chang, \{Jong Hee\} and Maria Kamenova and Sven Straumann and Jehuda Soleman and Ey{\"u}poglu, \{Ilker Y\} and Tony Catalan and Austin Lui and Theodosopoulos, \{Philip V\} and McDermott, \{Michael W\} and Fang Wang and Pedro G{\'o}es and Aria Jamshidi and Ricardo Komotar and Michael Ivan and Evan Luther and Luis Souhami and Marie-Christine Guiot and Tam{\'a}s Csonka and Toshiki Endo and Barrett, \{Olivia Claire\} and Randy Jensen and Tejpal Gupta and Patel, \{Akash J\} and Klisch, \{Tiemo J\} and Kim, \{Jun Won\} and Francesco Maiuri and Valeria Barresi and Tabernero, \{Mar{\'i}a Dolores\} and Simon Skyrman and Ian Law and David Scheie and Kristensen, \{Bjarne Winther\} and Munch, \{Tina N{\o}rgaard\} and Torstein Meling and K{\aa}re Fugleholm and Paul Blanche and Tiit Mathiesen",

note = "{\textcopyright} 2026. The Author(s).",

year = "2026",

month = apr,

day = "6",

doi = "10.1007/s00701-026-06846-y",

language = "English",

journal = "Acta Neurochirurgica",

issn = "0001-6268",

publisher = "Springer Wien",

}

TY - JOUR

T1 - The Ki-67 proliferation index and recurrence risk of intracranial meningioma

T2 - a multicenter, retrospective cohort study of 5,050 patients

AU - Mirian, Christian

AU - Jensen, Lasse Rehné

AU - Juratli, Tareq A

AU - Maier, Andrea Daniela

AU - Broechner, Anders

AU - Torp, Sverre H

AU - Shih, Helen A

AU - Morshed, Ramin A

AU - Young, Jacob S

AU - Magill, Stephen T

AU - Bertero, Luca

AU - Stummer, Walter

AU - Spille, Dorothee Cäcilia

AU - Brokinkel, Benjamin

AU - Oya, Soichi

AU - Miyawaki, Satoru

AU - Saito, Nobuhito

AU - Proescholdt, Martin

AU - Kuroi, Yasuhiro

AU - Gousias, Konstantinos

AU - Simon, Matthias

AU - Moliterno, Jennifer

AU - Prat-Acin, Ricardo

AU - Goutagny, Stéphane

AU - Prabhu, Vikram C

AU - Tsiang, John T

AU - Wach, Johannes

AU - Güresir, Erdem

AU - Yamamoto, Junkoh

AU - Kim, Young Zoon

AU - Lee, Joo Ho

AU - Kim, Daniel W

AU - Koshy, Matthew

AU - Perumal, Karthikeyan

AU - Baskaya, Mustafa K

AU - Cannon, Donald M

AU - Shrieve, Dennis C

AU - Suh, Chang-Ok

AU - Chang, Jong Hee

AU - Kamenova, Maria

AU - Straumann, Sven

AU - Soleman, Jehuda

AU - Eyüpoglu, Ilker Y

AU - Catalan, Tony

AU - Lui, Austin

AU - Theodosopoulos, Philip V

AU - McDermott, Michael W

AU - Wang, Fang

AU - Góes, Pedro

AU - Jamshidi, Aria

AU - Komotar, Ricardo

AU - Ivan, Michael

AU - Luther, Evan

AU - Souhami, Luis

AU - Guiot, Marie-Christine

AU - Csonka, Tamás

AU - Endo, Toshiki

AU - Barrett, Olivia Claire

AU - Jensen, Randy

AU - Gupta, Tejpal

AU - Patel, Akash J

AU - Klisch, Tiemo J

AU - Kim, Jun Won

AU - Maiuri, Francesco

AU - Barresi, Valeria

AU - Tabernero, María Dolores

AU - Skyrman, Simon

AU - Law, Ian

AU - Scheie, David

AU - Kristensen, Bjarne Winther

AU - Munch, Tina Nørgaard

AU - Meling, Torstein

AU - Fugleholm, Kåre

AU - Blanche, Paul

AU - Mathiesen, Tiit

PY - 2026/4/6

Y1 - 2026/4/6

N2 - 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.

AB - 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.

U2 - 10.1007/s00701-026-06846-y

DO - 10.1007/s00701-026-06846-y

M3 - Journal article

C2 - 41942766

SN - 0001-6268

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

ER -

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

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