Zhong D, Li X, Zhang G
Department of Pathology, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Bing Li Xue Za Zhi. 2001 Oct;30(5):345-9.
To investigate the clinical and pathological characteristics of astrocytoma and the factors related to pathologic gradings as well as prognosis in astrocytoma.
120 cases of the astrocytoma with complete clinical data were selected as the study group, of which 94 cases had follow-up data. 20 cases of normal brain tissue and demyelinating plaques with astrocyte hyperplasia were used as the control group. The expression of Ki-67, VEGF, collagen IV and TRT by immunohistochemical staining and detection of TRTmRNA and telomerase RNA by in situ hybridization were studied.
(1) Both astrocytoma and demyelinating lesions showed various positivity for Ki-67. The difference between different gradings of the astrocytoma and non-neoplastic lesions were significant(P < 0.01). Taking 8.5% of Ki-67 expression as threshold, there was significant difference between two survival curves indicating favorable and unfavorable prognosis in the tumor group respectively (P < 0.01). (2) Microvascular changes, such as the density of blood vessels, did not demonstrate any difference between grade I, II astrocytoma and normal tissue, but was significantly increased in grade III and IV astrocytoma and even more in the necrotic area (P < 0.01). The expression of VEGF correlated closely to the density of the blood vessel (P < 0.01). (3) The expression of TRT protein was negative in normal astrocytes but positive in proliferative disease and astrocytoma. The intensity of the positivity was enhanced by the grading of the tumor and correlated with the prognosis (P < 0.01). The expression of hTR, TRTmRNA was less than that of TRT but was well correlated to TRT expression.
Use of the cox-regression model in multivariate analysis shows that there are six parameters closely related to the prognosis of astrocytoma, of which the pathological grade being the most critical factor. Ratio of Ki-67 positivity, age of patient, duration of symptoms are also important factors, while microcystic changes in the tumor and expression of VEGF are independent favorable factors for astrocytoma.
探讨星形细胞瘤的临床及病理特征、与病理分级相关的因素以及星形细胞瘤的预后。
选取120例临床资料完整的星形细胞瘤患者作为研究组，其中94例有随访资料。选取20例正常脑组织及伴有星形细胞增生的脱髓鞘斑块作为对照组。采用免疫组织化学染色研究Ki-67、VEGF、IV型胶原和端粒酶逆转录酶（TRT）的表达，并通过原位杂交检测TRTmRNA和端粒酶RNA。
（1）星形细胞瘤和脱髓鞘病变的Ki-67均呈不同程度阳性。星形细胞瘤不同分级与非肿瘤性病变之间差异有统计学意义（P<0.01）。以Ki-67表达8.5%为界值，肿瘤组预后良好与不良的两条生存曲线差异有统计学意义（P<0.01）。（2）微血管变化，如血管密度，I、II级星形细胞瘤与正常组织之间无差异，但III、IV级星形细胞瘤明显增加，坏死区域更明显（P<0.01）。VEGF表达与血管密度密切相关（P<0.01）。（3）正常星形胶质细胞中TRT蛋白表达阴性，而在增殖性疾病和星形细胞瘤中呈阳性。阳性强度随肿瘤分级增加而增强，与预后相关（P<0.01）。人端粒酶RNA（hTR）、TRTmRNA的表达低于TRT，但与TRT表达密切相关。
多因素分析采用Cox回归模型显示，有6个参数与星形细胞瘤预后密切相关，其中病理分级是最关键因素。Ki-67阳性率、患者年龄、症状持续时间也是重要因素，而肿瘤微囊变和VEGF表达是星形细胞瘤独立的有利因素。
