复发胶质瘤的病理学特征及其预后分析  

Pathological characteristics of recurrent glioma and its prognosis analysis

作　　者：李聪[1,2] 奚少彦 陈银生[1] 邓美玲[1] 杨群英[1] 柯超[1] 赛克[1] 王翦[1] 牟永告[1] 陈忠平[1] Li Cong;Xi Shaoyan;Chen Yinsheng;Deng Meiling;Yang Qunying;Ke Chao;Sai Ke;Wang Jian;Mou Yonggao;Chen Zhongping(Department of Neurosurgery,Sun Yatsen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Department of Neurosurgery,Chinese Medicine Hospital of Guangdong Province,the Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]中山大学肿瘤防治中心,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心神经外科,广州510060 [2]广州中医药大学第二附属医院,广东省中医院神经外科,510120

出　　处：《中华神经外科杂志》2020年第3期227-231,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81672484,81372685,81872059);国家重点基础研究发展计划(973计划)(2015CB755505);广东省科技计划(2016A020213004);广州市科技计划重点项目(201508020125,2018030100560)。

摘　　要：目的探讨复发胶质瘤的病理学特征及其与患者预后的关系。方法回顾性分析2002年8月到2016年12月中山大学肿瘤防治中心神经外科收治的54例复发胶质瘤患者的临床资料。所有患者均再次行肿瘤切除术治疗,术后行病理学检测,包括肿瘤的世界卫生组织(WHO)分级、Ki-67指数、O6-甲基鸟嘌呤-DNA-甲基转移酶(MGMT)表达状态、异柠檬酸脱氢酶1(IDH1)状态;同时根据组织坏死程度、是否存在肿瘤细胞及肿瘤细胞活性情况进行病理学分型。采用Kaplan-Meier法分析患者的总生存期(OS)。进一步采用单因素和多因素Cox回归分析法判断影响复发胶质瘤患者OS的临床因素。结果54例患者的病理学检测结果,(1)WHO分级:Ⅱ级6例(11.1%)、Ⅲ级14例(25.9%)、Ⅳ级30例(55.6%),另4例(7.4%)未见肿瘤细胞。与初次手术比较,32例患者(59.2%)的WHO分级无变化,7例(13.0%)降低,15例(27.8%)升高。(2)Ki-67指数:共32例两次均行相关检测,其中15例的Ki-67指数降低、14例升高,另3例无改变。(3)IDH1状态:共29例两次均行相关检测,其中9例为突变型,20例为野生型;两次检测均未发生变化。(4)MGMT表达状态:共8例两次均行相关检测,6例无变化,其中3例表达阳性、3例表达阴性;另2例结果改变,均为初次表达阳性,二次表达阴性。(5)病理学分型:4例为坏死型,20例为混合型,30例为活性型。54例患者的随访时间为(16.1±3.2)个月(1.3~160.3)个月。Kaplan-Meier法分析结果显示,54例患者的中位OS(范围)为14.4个月(9.2~19.5个月)。多因素Cox回归分析结果显示,复发肿瘤WHO分级高(HR=2.80,95%CI:1.42~5.53,P<0.01)和术后未行放疗(HR=4.05,95%CI:1.41~11.64,P=0.01)是影响复发胶质瘤患者OS的独立危险因素。结论初步提示复发胶质瘤再次手术后的组织病理学会发生变化;再次手术后WHO病理分级低和术后行放疗是复发胶质瘤患者预后较好的临床因素。Objective To explore the pathological characteristics of recurrent glioma and its relationship with the patient′s prognosis.Methods A retrospective analysis was conducted on the clinical data of 54 patients with recurrent glioma treated at Neurosurgery Department,Sun Yat-sen University Cancer Center from August 2002 to December 2016.All patients underwent a second operation of tumor resection and postoperative pathological examinations including the World Health Organization(WHO)classification of the tumor,Ki-67 index,O6-methylguanine-DNA-methyltransferase(MGMT)status and isocitrate dehydrogenase 1(IDH1)status.The histopathological features of recurrent samples were classified according to presence of necrosis and tumor cells as well as activity of tumor cells.The overall survival(OS)of patients was analyzed using the Kaplan-Meier method.The univariate and multivariate Cox regression analysis was further conducted to determine the clinical factors affecting OS in patients with recurrent glioma.Results Pathological test results in 54 patients were as follows:(1)In terms of WHO grade,there were 6 cases of gradeⅡ(11.1%),14 cases of gradeⅢ(25.9%),30 cases of gradeⅣ(55.6%),and 4 cases(7.4%)without tumor cells.Compared with the first operation,there was no change in the WHO grade in 32 patients(59.2%),7(13.0%)had lower WHO tumor grades and 15(27.8%)had higher grades;(2)In terms of Ki-67 index,out of 32 cases undergoing two times of testing,15 cases had decreased Ki-67 index,14 had increased Ki-67 index,and 3 cases had unchanged index;(3)In terms of IDH1 status,out of 29 cases undergoing two times of relevant tests,9 cases were mutant and 20 were wild type;(4)In terms of MGMT status:out of 8 cases undergoing two times of relevant tests,6 cases consisting of 3 cases with positive expression and 3 cases with negative expression had no change,and the remaining 2 changed from positive expression in the first test to negative expression in the second test;(5)In terms of pathological classification,4 cases were necros

关 键 词：神经胶质瘤 复发 病理学 预后 

分 类 号：R73[医药卫生—肿瘤]