Giannini C, Scheithauer B W, Burger P C, Christensen M R, Wollan P C, Sebo T J, Forsyth P A, Hayostek C J
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
J Neuropathol Exp Neurol. 1999 Jan;58(1):46-53. doi: 10.1097/00005072-199901000-00006.
Using quantitative image analysis, we evaluated the MIB-1 labeling index (LI) in a large population of pilocytic (n = 131) and diffuse astrocytomas (n = 140), explored its significance as a prognostic predictor of survival, and compared it to other commonly accepted predictors, including grade and its histologic determinants, atypia, mitoses, endothelial proliferation, and necrosis. Diffuse astrocytomas were graded according to the St Anne-Mayo scheme and included 45 grade 2, 50 grade 3, and 45 grade 4 astrocytomas. In pilocytic astrocytomas, mean, median, and range of MIB-1 LIs were 1.1, 0.9, and 0-3.9%, respectively. In diffuse astrocytomas, these values were 2.3, 2, and 0-7.6% in grade 2; 6, 4.4, and 0.1-25.7% in grade 3; 9.1, 6, and 0.3-36% in grade 4. There was a significant difference in the distribution of MIB-1 LIs between pilocytic and diffuse grade 2 astrocytomas (p < 0.001), between grade 2 and grade 3 (p < 0.001), and between tumors of grade 3 and 4 (p = 0.014). Among pilocytic astrocytomas there was no association between survival and MIB-1 LI or any histologic parameter. In diffuse astrocytomas, MIB-1 LI was significantly correlated with grade as well as with mitotic activity (<0.001) and survival. While in diffuse astrocytomas of all grades, necrosis was the strongest factor associated with survival, in tumors of grades 2 and 3 the MIB-1 LI preceded other histologic parameters and, on multivariate analysis, remained the only feature predictive of survival. Grade 3 astrocytomas with a single "solitary" mitosis had a significantly lower MIB-I LI than did grade 3 tumors with >1 mitosis and, compared to the latter, had a significantly longer survival (p = 0.013), one not significantly different from patients with grade 2 astrocytomas. These findings suggest that the cutoff point between grade 2 and 3 in the St. Anne-Mayo scheme may not be optimal and may need to be revised.
我们采用定量图像分析方法，评估了大量毛细胞型星形细胞瘤（n = 131）和弥漫性星形细胞瘤（n = 140）的MIB-1标记指数（LI），探讨其作为生存预后预测指标的意义，并将其与其他公认的预测指标进行比较，包括分级及其组织学决定因素、异型性、有丝分裂、内皮细胞增殖和坏死。弥漫性星形细胞瘤根据圣安妮-梅奥方案分级，包括45例2级、50例3级和45例4级星形细胞瘤。在毛细胞型星形细胞瘤中，MIB-1 LI的平均值、中位数和范围分别为1.1%、0.9%和0 - 3.9%。在弥漫性星形细胞瘤中，2级的这些值分别为2.3%、2%和0 - 7.6%；3级为6%、4.4%和0.1 - 25.7%；4级为9.1%、6%和0.3 - 36%。毛细胞型和弥漫性2级星形细胞瘤之间、2级和3级之间以及3级和4级肿瘤之间的MIB-1 LI分布存在显著差异（p < 0.001、p < 0.001和p = 0.014）。在毛细胞型星形细胞瘤中，生存与MIB-1 LI或任何组织学参数之间无关联。在弥漫性星形细胞瘤中，MIB-1 LI与分级、有丝分裂活性（<0.001）和生存显著相关。虽然在所有级别的弥漫性星形细胞瘤中，坏死是与生存相关的最强因素，但在2级和3级肿瘤中，MIB-1 LI先于其他组织学参数，多因素分析显示它仍然是唯一的生存预测特征。有单个“孤立”有丝分裂的3级星形细胞瘤MIB-1 LI显著低于有>1个有丝分裂的3级肿瘤，与后者相比，生存期显著更长（p = 0.013），与2级星形细胞瘤患者的生存期无显著差异。这些发现表明，圣安妮-梅奥方案中2级和3级之间的分界点可能不是最佳的，可能需要修订。
