Struikmans H, Rutgers D H, Jansen G H, Tulleken C A, van der Tweel I, Battermann J J
Department of Radiotherapy, University Hospital, Utrecht, The Netherlands.
Acta Neurochir (Wien). 1998;140(2):140-7. doi: 10.1007/s007010050075.
The prognostic significance of clinically, histologically and flow cytometrically derived parameters was assessed in 49 glioma patients. With flow cytometry, DNA-index, S-phase fraction (SPF), 5-bromo-2'-deoxyuridine (BrdUrd)-labelling index (LI), and potential doubling time (Tpot) were determined. After univariate analysis of clinical variables such as, age, seizures as initial symptom, and duration of first symptom were found to be significantly associated both with proliferation rate and with local progression free survival (LPFS). Cytomorphological features such as, the presence or absence of mitosis, necrosis, and endothelial proliferation, were separately analysed and appeared to be significantly associated with LPFS. With respect to the cell proliferation markers, we observed a longer LPFS to be associated with a low SPF, a low LI, and a short Tpot. We did not observe a significant association between DNA-ploidy and LPFS. After multivariate analysis both of high and of low grade tumours, we found that neither LI, SPF, nor age had additional prognostic significance for cells in mitoses. We also demonstrated, that necrosis and endothelial proliferation had no additional prognostic significance to that for cells in mitoses. In the subgroup of low grade gliomas, in contrast to high grade gliomas, we noted prognostic significance for LI. We concluded, that i) the presence or absence of cells in mitoses was the strongest single prognosticator in gliomas, ii) in low grade gliomas LI holds prognostic significance.
对49例胶质瘤患者评估了临床、组织学和流式细胞术得出的参数的预后意义。通过流式细胞术，测定了DNA指数、S期分数（SPF）、5-溴-2'-脱氧尿苷（BrdUrd）标记指数（LI）和潜在倍增时间（Tpot）。对年龄、癫痫作为首发症状以及首发症状持续时间等临床变量进行单因素分析后发现，它们均与增殖率和无局部进展生存期（LPFS）显著相关。对有丝分裂、坏死和内皮细胞增殖等细胞形态学特征进行单独分析，发现它们与LPFS显著相关。关于细胞增殖标志物，我们观察到LPFS较长与低SPF、低LI和短Tpot相关。我们未观察到DNA倍体与LPFS之间存在显著关联。对高级别和低级别肿瘤进行多因素分析后，我们发现LI、SPF和年龄对有丝分裂细胞均无额外的预后意义。我们还证明，坏死和内皮细胞增殖对有丝分裂细胞也无额外的预后意义。在低级别胶质瘤亚组中，与高级别胶质瘤不同，我们注意到LI具有预后意义。我们得出结论：i）有丝分裂细胞的有无是胶质瘤最强的单一预后指标；ii）在低级别胶质瘤中，LI具有预后意义。
