Differences in Incidence of Meningioma Classes in Gender and Ethnicity

Meningiomas are a common intracranial neoplasm, accounting for 15 to 20% of primary brain tumors. Of these, 20 to 30% involve the skull base. While classically thought of as benign tumors, even histologically benign appearing lesions may behave aggressively. Advances in genetic sequencing and methylation analysis have facilitated identification of genetic and epigenetic subgroups that explain these phenotypic differences. We and others have previously published data supporting three genetically distinct types of meningiomas with differences in both driver mutations and propensity for aggressive behavior. These have been characterized as group A, B, and C tumors. The aggressively recurrent subtypes are of particular concern in the skull base, where total resection may be limited by proximity to and involvement of neurovascular structures. Different outcomes in patients based on gender and ethnicity has previously been noted. We aimed to review our series to determine if this is reflected in the molecular groups. We reviewed our series of 241 patients treated between 2011 and 2022 at a single institution. We first examined differences between ethnic groups. For the purpose of this study, we included white, Hispanic non-white, and African American patients. Other groups were not present in sufficient quantity to detect difference. White patients had a significantly higher rate of group A tumors (Pearson's chi-squared, p = 0.04), while non-white patients had significantly higher rate of group C tumors compared with white patients (Pearson's Chi-squared, p = 0.03). This did not translate to a difference in recurrence; however, this may be limited by follow-up. When stratified based on gender, women were found to have a significantly higher prevalence of group A tumors, while men had higher rate of group C (Pearson's chi-squared, p = 0.002). In keeping with this finding, men were found to have a 22% recurrence rate, compared with 8.8% in the female group (p = 0.002). These findings demonstrate that gender and ethnicity are risk factors for developing aggressive meningiomas. In particular, men, African American, and Hispanic patients are at an increased risk for developing group C meningiomas. This may contribute to the different outcomes seen between these groups. Differential outcomes between ethnic and gender groups are frequently overlooked in counseling patients and in guiding treatment. Understanding these differences can help guide surgical planning, patient counseling, and ultimately may dictate what targeted therapies may be effective in different patient populations.