FOXC1 as a molecular predictor of postoperative peritumoral edema resolution in meningiomas

BACKGROUND: Peritumoral brain edema (PTBE) is an important prognostic factor in meningiomas and may persist after tumor resection. While clinical and radiological predictors of postoperative PTBE resolution are known, the impact of molecular markers remained unclear. The aim of this study was to investigate the association of Forkhead box C1 (FOXC1) expression, as well as radiological and clinical parameters with postoperative PTBE resolution. MATERIALS AND METHODS: We conducted a retrospective single-center study with 75 histopathologically confirmed meningiomas. Pre- and postoperative PTBE volumes were quantified using volumetric MRI-based segmentation. Postoperative PTBE resolution was defined as the relative percentage reduction in PTBE volume compared with preoperative baseline. In addition, preoperative MRI datasets were analyzed for radiological tumor characteristics using 3D Slicer. FOXC1 expression was assessed immunohistochemically. Optimal cut-off values were determined using receiver operating characteristics (ROC) curve analysis. Univariate and multivariate analyses were performed to identify independent predictors of postoperative PTBE resolution. RESULTS: In multivariate analysis, higher FOXC1 expression was independently associated with greater postoperative PTBE resolution (OR: 6.36, 95% CI: 2.06-19.60; p < 0.001). In addition, larger tumor volume was independently associated with lower PTBE resolution (OR = 0.25, 95% CI: 0.07-0.89, p = 0.029). CONCLUSION: Higher FOXC1 expression was independently associated with greater postoperative PTBE resolution. These findings require validation in larger independent cohorts before clinical implementation.