Increased CD44 Expression in Primary Meningioma: Its Clinical Significance and Association with Peritumoral Brain Edema

Abstract Purpose: CD44 is a major cell surface receptor involved in cell adhesion and migration. The overexpression of CD44 is a poor prognostic factor in many neoplasms, including meningiomas. This study investigated the association between CD44 gene expression and clinical signatures of primary meningiomas. Methods: CD44 gene expression was quantitatively evaluated by snap-freezing tumor tissues obtained from 106 patients with primary meningioma. The relationships between CD44 expression and clinical signatures of meningiomas, including histological malignancy, tumor volume, and peritumoral brain edema (PTBE), were analyzed. PTBE was assessed using the Steinhoff classification system (from SC-0 to SC-III). Results: CD44 gene expression in World Health Organization grade 2 and 3 meningiomas was significantly higher than that in grade 1 meningiomas. In addition, CD44 expression increased with the severity of PTBE. Particularly, among the grade 1 meningiomas or small-sized tumors (maximum tumor diameter less than 43 mm), CD44 expression in tumors with severe PTBE (SC-II/III) was significantly higher than that in tumors without or mild PTBE (SC-0/I). Multivariate logistic regression analysis also revealed that overexpression of CD44was an independent significant factor of severe PTBE development in primary meningiomas. Conclusion: In addition to tumor cell aggressiveness, CD44expression promotes the development of PTBE in meningioma. Since PTBE is a strong factor of tumor-related epilepsy or cognitive dysfunction in patients with meningioma, CD44 is thus a potential therapeutic target in meningioma with PTBE.