Caspase-3 and Survivin Expression in Primary Atypical and Malignant Meningiomas

Objective . Information about possible prognostic factors of the survival of patients with atypical and malignant meningiomas (AMM) is sparse. The aim of our study was to evaluate prognostic significance of apoptotic marker caspase-3 and apoptotic inhibitor survivin in a series of primary AMM. Methods . 86 AMM (76 atypical and 10 malignant) were analyzed. Caspase-3 and survivin expression was evaluated immunohistochemically. The correlation between caspase-3, survivin, and other possible factors of meningioma recurrence was evaluated. Uni- and multivariate recurrence-free survival (RFS) and overall survival (OS) analyses were performed. Results . The intensity of caspase-3 expression correlated with the tumor grade ( P = 0.004), the proliferation index ( P = 0.019), and the mitotic count ( P = 0.013). Survivin tended to be more expressed in female patients ( P = 0.072). Survivin expression was stronger in malignant compared to atypical meningiomas, however, the difference was not statistically important ( P = 0.491). Neither survivin nor caspase-3 expression significantly predicted OS or RFS in patients with AMM. Conclusions . Strong caspase-3 expression on AMM cells could reflect a cellular attempt at the homeostatic autoregulation of the tumor size. Survivin expression on AMM cells is similar to the survivin expression reported on benign meningiomas. Caspase-3 and survivin expression has no prognostic significance on the survival of patients with AMM.