Correlation of VEGF and Ki-67 Expression with Histopathological Features and WHO Grade in Meningioma: A Cross-sectional Study

Abstract

BACKGROUND: Meningiomas, the most common primary central nervous system tumors, exhibit variable clinical behavior. While World Health Organization (WHO) grading is standard, complementary biomarkers are needed to refine prognostication. Vascular Endothelial Growth Factor (VEGF) and Ki-67 are potential indicators of angiogenesis and proliferation that may enhance diagnostic precision. This study aimed to evaluate the correlation between VEGF and Ki-67 expression with the histopathological features and WHO 2021 grade of meningiomas. METHODS: In this cross-sectional study, 73 formalin-fixed, paraffin-embedded meningioma specimens were analyzed. Tumors were graded per WHO 2021 criteria. VEGF expression (H-score) and Ki-67 labeling index (LI) were assessed via immunohistochemistry and correlated with histopathological features, including mitotic activity and brain invasion. Statistical analysis utilized chi-square, Kruskal-Wallis, and Spearman tests (p<0.05). RESULTS: Most tumors were WHO Grade I (83.6%). Higher VEGF expression was significantly associated with mitotic activity, brain invasion, and hypercellularity, and was increased in high-grade (WHO II-III) meningiomas. Ki-67 labeling index showed a significant positive correlation with WHO grade and other aggressive histopathological features. CONCLUSION: Both VEGF and Ki-67 are associated with aggressive histopathology in meningiomas. Ki-67 expression strongly correlates with overall WHO grade, whereas VEGF is more indicative of specific invasive traits. Their combined evaluation provides a valuable molecular adjunct to conventional histology, potentially refining risk stratification, particularly in borderline cases. However, interpretation of these findings is limited by the single-center, cross-sectional design and the relatively small number of high-grade and invasive cases.

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