中枢神经系统孤立性纤维性肿瘤分级演变对临床病理学和预后分层的影响  

Evolution of grading for solitary fibrous tumors of the central nervous system:a clinical pathological and prognostic analysis

作　　者：李晓玲 张桦[3,4] 胡承聪 周剑锋 庄梦艺 范欣欣 胡力文 陈余朋[2,5] 黄茜[2,5] 张声[2,5] 王行富[2,5] Li Xiaoling;Zhang Hua;Hu Chengcong;Zhou Jianfeng;Zhuang Mengyi;Fan Xinxin;Hu Liwen;Chen Yupeng;Huang Qian;Zhang Sheng;Wang Xingfu(Department of Pathology,the Second Hospital of Longyan,Longyan 364000,China;Department of Pathology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Radiology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Radiology,Binhai Campus of the First Affiliated Hospital,National Regional Medical Center,Fujian Medical University,Fuzhou 350212,China;Department of Pathology,Binhai Campus of the First Affiliated Hospital,National Regional Medical Center,Fujian Medical University,Fuzhou 350212,China;Fujian Medical University,Basic Medical College,Five-Year Clinical Medicine Program,Fuzhou 350005,China)

机构地区：[1]龙岩市第二医院病理科,龙岩364000 [2]福建医科大学附属第一医院病理科,福州350005 [3]福建医科大学附属第一医院医学影像科,福州350005 [4]福建医科大学附属第一医院滨海院区国家区域医疗中心医学影像科,福州350212 [5]福建医科大学附属第一医院滨海院区国家区域医疗中心病理科,福州350212 [6]福建医科大学基础医学院,福州350005

出　　处：《中华肿瘤杂志》2025年第3期275-282,共8页Chinese Journal of Oncology

基　　金：福建省卫生健康科技计划项目(2021QNA073);福建医科大学启航基金项目(2021QH1090);福建省大学生创新创业训练计划项目(S202310392025)。

摘　　要：目的探讨2021年WHO第5版中枢神经系统(CNS)肿瘤分类对孤立性纤维性肿瘤(SFT)的命名和分级体系进行了重大修订后,CNS SFT的分级变化及其与临床病理学特征和预后的关系。方法回顾性分析2006年3月至2021年6月福建医科大学附属第一医院诊断为CNS SFT的患者(82例)的临床病理资料,根据WHO第5版CNS肿瘤分类标准对患者的病理进行重新分级,并对组织形态学、免疫组织化学特征以及临床影像资料进行综合分析。结果患者年龄21~83岁,中位年龄48岁。82例患者完成了随访,死亡10例,复发24例,转移5例。MRI成像显示,SFT在T1加权像上呈等信号,T2加权像(T2WI)上信号复杂,且胶原纤维含量增加时信号强度降低。根据2021年WHO第5版CNS肿瘤分类的分级标准,SFT的分级发生了显著变化,1级SFT从2016年标准的10例增加至39例,而2级和3级相应减少。2016年分级系统与患者总生存时间(OS)有关(P=0.009),而2021年分级系统则未达统计学意义。两版分级系统均与组织学表型、Ki-67指数、核分裂象以及坏死等有关(P<0.05)。所有患者均表达STAT6,波形蛋白、CD99、BCL-2及CD34不同程度表达。Ⅳ型胶原纤维的染色强度与患者OS有关(P=0.017)。结论CNS SFT新的分级系统变动大,其与OS的关联性尚需进一步验证。对SFT中胶原纤维的含量及其细微结构的深入研究,可能对患者的预后评估和治疗方案的制定具有重要的临床意义。通过定量分析T2WI信号强度,可能为术前初步评估SFT的胶原纤维含量提供一种新方法。Objective The 5th edition of the WHO classification of central nervous system(CNS)tumors in 2021 made significant revisions to the nomenclature and grading system of solitary fibrous tumors(SFT).This study aimed to explore the changes in the grading of CNS SFT and its relationship with clinical pathological features and prognosis.Methods This study retrospectively reviewed the clinical and pathological data of 82 patients with CNS SFT diagnosed at the First Affiliated Hospital of Fujian Medical University from March 2006 to June 2021,reassessed their grading according to the WHO 5th edition CNS tumor classification,and conducted a comprehensive analysis of their histological morphology,immunohistochemical characteristics,and clinical imaging data.Results The age of the patients ranged from 21 to 83 years,with a median age of 48 years.Follow-up was completed for 82 patients,during which 10 patients died,24 recurred,and 5 metastasized.MRI imaging showed that SFT exhibited isointense signals on T1-weighted imaging(T1WI)and complex signals on T2-weighted imaging(T2WI),with signal intensity decreasing as the content of collagen fibers increased.According to the 2021 grading criteria,there was a significant change in the grading of SFT,with the number of grade 1 SFT increasing from 10 cases under the 2016 standard to 39 cases,while the number of grade 2 and 3 SFT decreased accordingly.The 2016 grading system was significantly correlated with the overall survival(OS)of patients(P=0.009),while the 2021 grading system did not reach statistical significance.Both grading systems were correlated with histological phenotype,Ki-67 index,mitotic figures,and necrosis(P<0.05).All cases expressed STAT6,and showed varying degrees of expression of vimentin,CD99,BCL-2,and CD34.The staining intensity of typeⅣcollagen fibers,as analyzed semi-quantitatively,was correlated with the OS of the patients(P=0.017).Conclusions The new grading system for CNS SFT has undergone significant changes,and its association with OS requires further va

关 键 词：孤立性纤维性肿瘤 中枢神经系统 WHO分级 预后 胶原纤维 

分 类 号：R73[医药卫生—肿瘤]