LAUSR

BACKGROUND Identifying meningiomas that behave aggressively has proven challenging based on histopathology alone. Several authors have sought to supplement the World Health Organization (WHO) grading system with the use of molecular markers. Although some genetic alterations have been associated with prognosis of patients, it is imperative to validate such markers in different patient cohorts. OBJECTIVE To establish the utility of telomerase reverse transcriptase promoter (TERTp) mutation as a prognostic factor in meningiomas. METHODS This retrospective study included grade 1 and grade 2 meningiomas in patients aged greater than 18 years operated between 2010 and 2015 at our institute, with a minimum follow-up of 2 years. They were studied for TERTp mutation. RESULTS Seventy-one patients fulfilled the above criteria. TERTp mutation was found in five patients (7.04%), while 66 patients had wild-type TERTp. Seventeen patients had recurrence during the follow-up period. All meningiomas with TERTp mutation recurred, while TERTp wild-type meningiomas harbored a 18.2% (12/66) rate of recurrence (P < 0.001). The presence of TERTp mutation was significantly associated with shorter progression-free survival compared to the wild type (28.20 months, versus 93.18 months, P = 0.003). CONCLUSION Our report showed a 100% recurrence rate among TERTp mutant meningiomas in a previously unrepresented demographic cohort. This highlights the need for molecular markers as adjuncts to the current WHO grading system, which may help identify meningiomas with aggressive behavior among grade 1 and grade 2 tumors and thus tailor management. Further avenues for research include targeting telomerase for therapeutics.