Is DNA methylation a ray of sunshine in predicting meningioma prognosis

Meningioma is the most common intracranial tumor, and recent studies suggest increased importance of further research on malignant meningioma. According to the World Health Organization (WHO) grading, meningioma is classified into 15 subtypes with three grades of malignancy. However, due to a lack of descriptions of molecular subtypes, genetic mutations, or other features, there were deficiencies in the WHO classification. The DNA methylation-based meningioma classification published in 2017 used DNA copy number analysis, mutation profiling, and RNA sequencing to distinguish six clinically relevant methylation classes, which contributed to a better prediction of tumor recurrence and prognosis. Further studies indicated that gene variation and gene mutations, such as those in neurofibromin 2 (NF2) and BRCA1, were related to the high WHO grade, malignant invasion, and recurrence. Among the mutant genes described above, some have been associated with differential DNA methylation. Herein, we searched for articles published in PubMed and Web of Science from January 2000 to May 2020 PubMed by entering the keywords “meningioma”, “methylation” and “gene mutation”, and found a number of published studies that analyzed DNA methylation in meningiomas. In this review, we summarize the key findings of recent studies on the methylation status and genetic mutations of meningioma and discuss the current deficits of WHO grading. We also propose that methylation-based meningioma classification can provide clues in the assessment of individual risk of meningioma recurrence, which is associated with clinical benefits for patients.