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 ( ), the proliferation index ( ), and the mitotic count ( ). Survivin tended to be more expressed in female patients ( ). Survivin expression was stronger in malignant compared to atypical meningiomas, however, the difference was not statistically important ( ). 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. 1. Introduction Malignant meningiomas (MM) account for 1–3% and atypical meningiomas (AM) for about 20% of all meningiomas [1]. Prognostic factors associated with recurrence of atypical and malignant meningiomas (AMM) are not agreed upon. Primary AMM are rather sporadic entities, so only few studies on larger series have been performed so far [2–5]. High mitotic count, brain invasion, and parasagittal location are the strongest predictors of shorter recurrence-free survival (RFS) in patients with primary AMM [5]. Apoptosis, a regulated form of cellular self-degradation, plays an important role in embryological development as well as in many pathological processes in adults, including tumorogenesis. While necrosis is a direct consequence of cellular ischemia and is dependent exclusively of external factors, apoptosis is triggered inside the cell. It can be regarded as a cellular response to stimuli not immediately lethal. Anything producing cell necrosis by direct cell destruction can induce apoptosis if the cell initially survives. Tumor growth depends on balance between cell gain and cell loss, apoptosis being the most significant component of
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