Woodburn R T, Azzarelli B, Montebello J F, Goss I E
Department of Radiation Oncology, Indiana University Medical Center, Indianapolis 46202, USA.
J Neurooncol. 2001 Mar;52(1):57-62. doi: 10.1023/a:1010691330670.
Intense p53 immunostaining may predict for a poor prognosis in central nervous system primitive neuroectodermal tumor of childhood.
Medulloblastoma is a common childhood primary brain tumor. Potential prognostic indicators for patients with local disease are age, extent of resection, and gender. However, none of these are well established. Immunohistologic staining is a potentially useful means to identify high-risk patients. The purpose of this clinical pathologic study was to investigate the prognostic significance of GFAP, synaptophysin, Ki-67, and p53 immunostaining in medulloblastoma/central nervous system primitive neuroectodermal tumors (CNS PNETs.)
The records of 40 patients with CNS PNETs were reviewed. Their surgical specimens were immunostained for p53, glial fibrillary acidic protein (GFAP), synaptophysin, and Ki-67. The p53 specimens were scored blindly for the intensity of staining of nuclei (intense vs weak) and the quantity of cells stained. The Ki-67, GFAP, and synaptophysin specimens were analyzed for quantity of cells stained.
Ten patients' specimens stained intensely for the p53 protein. Eleven had weakly staining nuclei. Nineteen specimens had no staining. The patients with specimens that stained intensely had a statistically significant decreased disease free survival (P = 0.03). Mere presence or quantity of p53 nuclear staining did not correlate with disease free survival. Immunohistochemical staining for Ki-67, GFAP, and synaptophysin did not correlate with disease free survival. Clinical parameters of age, gender, and extent of resection also did not approach statistical significance for disease free survival.
Intense nuclear staining for p53 was the only variable in this clinical pathologic study that reached statistical significance for disease free survival. This suggests that intense staining for p53 may be the most important prognostic indicator for non-metastatic CNS PNETs. p53 Immunostaining with antibodies against p53 in CNS PNETs should be studied in a multi-institutional setting with larger numbers of patients.
强烈的p53免疫染色可能预示儿童中枢神经系统原始神经外胚层肿瘤预后不良。
髓母细胞瘤是常见的儿童原发性脑肿瘤。局部病变患者的潜在预后指标包括年龄、切除范围和性别。然而，这些指标均未得到充分证实。免疫组织化学染色是识别高危患者的一种潜在有用方法。本临床病理研究的目的是探讨胶质纤维酸性蛋白（GFAP）、突触素、Ki-67和p53免疫染色在髓母细胞瘤/中枢神经系统原始神经外胚层肿瘤（CNS PNETs）中的预后意义。
回顾40例CNS PNETs患者的病历。对其手术标本进行p53、胶质纤维酸性蛋白（GFAP）、突触素和Ki-67免疫染色。对p53标本的细胞核染色强度（强或弱）和染色细胞数量进行盲法评分。分析Ki-67、GFAP和突触素标本的染色细胞数量。
10例患者的标本p53蛋白染色强烈。11例细胞核染色较弱。19例标本无染色。标本染色强烈的患者无病生存期在统计学上显著降低（P = 0.03）。p53核染色的单纯存在或数量与无病生存期无关。Ki-67、GFAP和突触素的免疫组织化学染色与无病生存期无关。年龄、性别和切除范围等临床参数在无病生存期方面也未达到统计学意义。
p53核染色强烈是本临床病理研究中唯一与无病生存期具有统计学意义的变量。这表明p53染色强烈可能是非转移性CNS PNETs最重要的预后指标。应在多机构环境中对更多患者进行CNS PNETs中针对p53抗体的p53免疫染色研究。
