通过手术和有时放射治疗肿瘤和硬脑膜边缘是脑膜瘤治疗的基石。分子分类提供了对疾病生物学的见解；然而，对治疗的反应仍然存在差异。在这项研究中，我们使用 RTOG-0539 2 期试验中 2,824 个脑膜瘤的回顾性数据，包括 1,686 个肿瘤和 100 个前瞻性脑膜瘤的分子数据来定义治疗反应的分子生物标志物。使用倾向评分匹配，我们发现大体肿瘤切除与所有分子组的较长无进展生存期（PFS）以及增殖性脑膜瘤的较长总生存期相关。与未治疗（Simpson 3 级）相比，硬脑膜边缘治疗（Simpson 1/2 级）可延长 PFS。分子组分类预测了对放射治疗的反应，包括 RTOG-0539 队列。我们随后开发了一种分子模型来预测放射治疗的反应，该模型比标准护理分类更好地区分结果。这项研究强调了分子分析在完善手术和放射治疗决策方面的潜力。© 2024。作者。

Treatment of the tumor and dural margin with surgery and sometimes radiation are cornerstones of therapy for meningioma. Molecular classifications have provided insights into the biology of disease; however, response to treatment remains heterogeneous. In this study, we used retrospective data on 2,824 meningiomas, including molecular data on 1,686 tumors and 100 prospective meningiomas, from the RTOG-0539 phase 2 trial to define molecular biomarkers of treatment response. Using propensity score matching, we found that gross tumor resection was associated with longer progression-free survival (PFS) across all molecular groups and longer overall survival in proliferative meningiomas. Dural margin treatment (Simpson grade 1/2) prolonged PFS compared to no treatment (Simpson grade 3). Molecular group classification predicted response to radiotherapy, including in the RTOG-0539 cohort. We subsequently developed a molecular model to predict response to radiotherapy that discriminates outcome better than standard-of-care classification. This study highlights the potential for molecular profiling to refine surgical and radiotherapy decision-making.© 2024. The Author(s).