Wessels P H, Hopman A H N, Kubat B, Kessels A G H, Hoving E W, Ummelen M I J, Ramaekers F C S, Twijnstra A
Department of Neurology, Research Institute Growth and Development (GROW), University Hospital Maastricht, The Netherlands.
Br J Cancer. 2003 Jul 7;89(1):128-34. doi: 10.1038/sj.bjc.6601067.
The clinical course of astrocytoma grade II (AII) is highly variable and not reflected by histological characteristics. As one of the best prognostic factors, higher age identifies rapid progressive A II. For patients over 35 years of age, an aggressive treatment is normally propagated. For patients under 35 years, there is no clear guidance for treatment choices, and therefore also the necessity of histopathological diagnosis is often questioned. We studied the additional prognostic value of the proliferation index and the detection of genetic aberrations for patients with A II. The tumour samples were obtained by stereotactic biopsy or tumour resection and divided into two age groups, that is 18-34 years (n=19) and > or =35 years (n=28). Factors tested included the proliferation (Ki-67) index, and numerical aberrations for chromosomes 1, 7, and 10, as detected by in situ hybridisation (ISH). The results show that age is a prognostic indicator when studied in the total patient group, with patients above 35 years showing a relatively poor prognosis. Increased proliferation index in the presence of aneusomy appears to identify a subgroup of patients with poor prognosis more accurately than predicted by proliferation index alone. We conclude that histologically classified cases of A II comprise a heterogeneous group of tumours with different biological and genetic constitution, which exhibit a highly variable clinical course. Immunostaining for Ki-67 in combination with the detection of aneusomy by ISH allows the identification of a subgroup of patients with rapidly progressive A II. This is an extra argument not to defer stereotactic biopsy in young patients with radiological suspicion of A II.
二级星形细胞瘤（AII）的临床病程高度可变，无法通过组织学特征反映出来。作为最佳预后因素之一，较高的年龄预示着AII会快速进展。对于35岁以上的患者，通常主张积极治疗。对于35岁以下的患者，治疗选择尚无明确指导，因此组织病理学诊断的必要性也常受到质疑。我们研究了增殖指数和基因异常检测对AII患者的额外预后价值。通过立体定向活检或肿瘤切除获取肿瘤样本，并分为两个年龄组，即18 - 34岁（n = 19）和≥35岁（n = 28）。检测的因素包括增殖（Ki - 67）指数，以及通过原位杂交（ISH）检测到的1、7和10号染色体的数目异常。结果表明，在整个患者组中研究时，年龄是一个预后指标，35岁以上的患者预后相对较差。在存在非整倍体的情况下，增殖指数增加似乎比单独的增殖指数更能准确地识别出预后不良的患者亚组。我们得出结论，组织学分类的AII病例包括一组具有不同生物学和基因构成的异质性肿瘤，其临床病程高度可变。Ki - 67免疫染色结合ISH检测非整倍体能够识别出快速进展的AII患者亚组。这是一个额外的理由，说明对于影像学怀疑为AII的年轻患者不应推迟立体定向活检。
