A Molecularly Integrated Grade for Meningioma

Published in Neuro-Oncology, our team developed a molecularly integrated grading system that redefines how meningiomas, the most common primary brain tumors, are classified and managed. By combining traditional histopathologic features with chromosomal copy-number alterations (CNAs) across more than 700 tumors, we discovered that genomic instability, particularly loss of 1p, 3p, 4, 6, 10, 14q, 18, 19, or CDKN2A, drives recurrence risk far more precisely than the current WHO system. This new three-tier "Integrated Grade" reclassified nearly one-third of meningiomas, uncovering hidden high-risk biology in tumors that appeared benign and identifying lower-risk tumors previously labeled aggressive. The Integrated Grade achieved markedly stronger predictive performance than WHO grade (5-year AUC = 0.82 vs 0.63) and was validated across independent cohorts and genomic platforms. Because CNAs can be profiled using widely available technologies, this framework is immediately applicable in both academic and community settings. Together, these findings establish a simple, scalable, and genomically informed grading model that advances precision diagnostics and enables more personalized surveillance, treatment, and clinical trial design for patients with meningioma.