Giannini C, Scheithauer B W, Weaver A L, Burger P C, Kros J M, Mork S, Graeber M B, Bauserman S, Buckner J C, Burton J, Riepe R, Tazelaar H D, Nascimento A G, Crotty T, Keeney G L, Pernicone P, Altermatt H
Department of Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Neuropathol Exp Neurol. 2001 Mar;60(3):248-62. doi: 10.1093/jnen/60.3.248.
Prognostic value of histological grading of oligodendroglial tumors is controversial and interobserver reproducibility in grading of these tumors is unknown. Seven neuropathologists and 6 surgical pathologists experienced in brain tumor-diagnosis assessed 124 oligodendroglial tumors operated at the Mayo Clinic (1960-1990). Among histologic parameters upon which current oligodendroglioma grading systems are based, only high cellularity, presence of mitoses, microcalcifications, endothelial hypertrophy, endothelial proliferation, and necrosis appeared to be reproducible. Reproducible histologic features, based on consensus ratings among neuropathologists (defined as > 60%), were evaluated for the association with cause-specific survival by fitting Cox regression models. By univariate analysis, a significant association with survival was found for age, high cellularity, presence of mitoses, endothelial hypertrophy and proliferation and necrosis. On multivariable analysis with a stepwise variable selection method, only age and presence of endothelial proliferation were found to be independently associated with survival with a discriminatory index of the model of 0.68. Mitotic index was significantly associated with survival based on the grading from each separate neuropathologist, but it was not based on consensus, most likely because this was classified as indeterminate in 54% of cases. Alternatively, "models fit" considering the assessment of single neuropathologists, identified a model based on age and on mitotic index with similar discriminatory indices of 0.69-0.7. Our study found few factors independently associated with cause specific-survival among morphological parameters. These findings are consistent with the present WHO stratification of oligodendrogliomas into low- and high-grade variants.
少突胶质细胞瘤组织学分级的预后价值存在争议，且这些肿瘤分级的观察者间可重复性尚不清楚。7名神经病理学家和6名有脑肿瘤诊断经验的外科病理学家对梅奥诊所（1960 - 1990年）手术的124例少突胶质细胞瘤进行了评估。在当前少突胶质细胞瘤分级系统所依据的组织学参数中，只有高细胞密度、有丝分裂、微钙化、内皮细胞肥大、内皮细胞增殖和坏死似乎具有可重复性。基于神经病理学家间的共识评分（定义为> 60%）的可重复组织学特征，通过拟合Cox回归模型评估其与特定病因生存率的相关性。单因素分析发现，年龄、高细胞密度、有丝分裂、内皮细胞肥大、增殖和坏死与生存率有显著相关性。采用逐步变量选择法进行多因素分析时，仅发现年龄和内皮细胞增殖与生存率独立相关，模型的判别指数为0.68。根据每位独立神经病理学家的分级，有丝分裂指数与生存率显著相关，但基于共识则不然，很可能是因为在54%的病例中其被归类为不确定。另外，考虑单个神经病理学家评估的“模型拟合”确定了一个基于年龄和有丝分裂指数的模型，其判别指数相似，为0.69 - 0.7。我们的研究发现形态学参数中很少有因素与特定病因生存率独立相关。这些发现与世界卫生组织目前将少突胶质细胞瘤分为低级别和高级别变体的分层一致。
