Cillekens J M, Beliën J A, van der Valk P, Faes T J, van Diest P J, Broeckaert M A, Kralendonk J H, Kamphorst W
Department of Pathology, Free University Hospital, Amsterdam, The Netherlands.
J Neurooncol. 2000;46(1):23-43. doi: 10.1023/a:1006496328729.
Previous glioma studies have described separate grading systems for oligodendrogliomas and astrocytomas. Many of these gliomas contain mixtures of neoplastic astrocytes and oligodendrocytes. Prognosis may be related to the percentages of these neoplastic components. Previous survival/grading studies have been limited to histopathological features but have not evaluated the importance of percentages of neoplastic components. This study attempted to perceive the relative importance of percentages of neoplastic astrocytes and oligodendrocytes for definition of astroglial, oligodendroglial and mixed oligoastroglial tumors. After determination of these limits we explored the possibility to develop a grading system for common supratentorial gliomas based on reproducible histopathological features.
A retrospective study was performed of 362 cases of unselected supratentorial glioma. One hundred and thirty-eight binary and nine continuous histopathological variables, amongst which percentages of neoplastic astrocytes and oligodendrocytes, were scored and related to survival. Only well reproducible histological features were accepted in Cox regression to define glioma grades.
Supratentorial gliomas appeared to be composed of variable percentages of neoplastic oligodendrocytes and astrocytes, but this spectrum did not correspond to a continuous change in prognosis. Gliomas containing 30% or more neoplastic oligodendrocytes had a slightly better outcome (p < 0.0432) but higher percentages did not further improve prognosis. Percentages of neoplastic astrocytes were not correlated to survival. We therefore propose to designate gliomas containing 30% or more neoplastic oligodendrocytes as oligodendroglial tumors, and others as astroglial tumors. From a prognostic point of view there is no need to recognize mixed oligoastrocytomas. An interesting finding was the recognition of a low grade glioma group with Rosenthal fibers, which had the longest postoperative survival. Another prognosticator of interest concerns the mitotic rate as a continuous variable. Atypical mitoses indicated the worst survival, after necrosis. It was possible to develop a grading system for all supratentorial gliomas using six reproducible histological parameters: necrosis, atypical mitoses, the mitotic rate, endothelial proliferative activity, percentage of neoplastic oligodendrocytes and Rosenthal fibers. This resulted in four grades for astroglial tumors (p < 0.002) and three grades for oligodendroglial tumors (p < 0.008) which differed significantly within each group with respect to survival.
以往的胶质瘤研究针对少突胶质细胞瘤和星形细胞瘤描述了不同的分级系统。许多这类胶质瘤包含肿瘤性星形胶质细胞和少突胶质细胞的混合成分。预后可能与这些肿瘤性成分的百分比有关。以往的生存/分级研究局限于组织病理学特征，未评估肿瘤性成分百分比的重要性。本研究试图明确肿瘤性星形胶质细胞和少突胶质细胞百分比对于星形胶质细胞瘤、少突胶质细胞瘤及少突星形胶质细胞瘤混合瘤定义的相对重要性。确定这些界限后，我们探讨了基于可重复的组织病理学特征制定幕上常见胶质瘤分级系统的可能性。
对362例未经选择的幕上胶质瘤病例进行回顾性研究。对138个二元和9个连续的组织病理学变量进行评分并与生存情况相关联，其中包括肿瘤性星形胶质细胞和少突胶质细胞的百分比。Cox回归中仅接受可良好重复的组织学特征来定义胶质瘤分级。
幕上胶质瘤似乎由不同百分比的肿瘤性少突胶质细胞和星形胶质细胞组成，但这种变化范围与预后的连续变化并不对应。肿瘤性少突胶质细胞占30%或更多的胶质瘤预后稍好（p < 0.0432），但更高的百分比并未进一步改善预后。肿瘤性星形胶质细胞的百分比与生存无相关性。因此，我们建议将肿瘤性少突胶质细胞占30%或更多的胶质瘤指定为少突胶质细胞瘤，其他的指定为星形胶质细胞瘤。从预后角度看，无需识别少突星形胶质细胞瘤混合瘤。一个有趣的发现是识别出一组带有罗森塔尔纤维的低级别胶质瘤，其术后生存期最长。另一个有趣的预后因素是将有丝分裂率作为连续变量。非典型有丝分裂提示坏死之后最差的生存情况。利用六个可重复的组织学参数：坏死、非典型有丝分裂、有丝分裂率、内皮细胞增殖活性、肿瘤性少突胶质细胞百分比和罗森塔尔纤维，有可能为所有幕上胶质瘤制定一个分级系统。这导致星形胶质细胞瘤分为四级（p < 0.002），少突胶质细胞瘤分为三级（p < 0.008），每组内不同级别在生存方面有显著差异。
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