Comparative Analysis of Matrix Metalloproteinase-9 and Estrogen Receptor Expression in Intradural Extramedullary Meningioma and Their Association with Postoperative Outcomes: A 2020–2025 Study at H. Adam Malik Hospital

Abstract

This study analyzes the association between the expression of Matrix Metalloproteinase-9 (MMP-9) and Estrogen Receptor (ER) biomarkers in intradural extramedullary (IDEM) spinal meningioma tissue and neurological deficit recovery, clinical outcomes, and postoperative complications. An observational analytic cross-sectional study was conducted on 20 patients following IDEM spinal meningioma resection at H. Adam Malik General Hospital Medan from 2020 to 2025. Biomarker expression was evaluated using immunohistochemistry, while clinical outcomes were assessed using the modified Rankin Scale (mRS) and statistically analyzed. The majority of patients were female (80%), with the thoracic region being the most frequent tumor location (75%). MMP-9 and ER expression showed a very strong negative correlation with neurological deficit recovery (r = -0.815 and r = -0.806; p < 0.001). The improved patient group exhibited significantly lower median MMP-9 and ER scores (p < 0.001). High MMP-9 expression and positive ER status were also significantly associated with an increased incidence of postoperative complications (OR = 6.00; p < 0.001). High MMP-9 expression and positive ER status in IDEM spinal meningioma tissue are associated with minimal neurological recovery, poorer clinical outcomes, and a higher risk of postoperative complications. Both biomarkers hold potential as prognostic predictors for patient risk stratification.