Preusser Matthias, Heinzl Harald, Gelpi Ellen, Schonegger Katharina, Haberler Christine, Birner Peter, Marosi Christine, Hegi Monika, Gorlia Thierry, Hainfellner Johannes A
Institute of Neurology, Medical University Vienna, Vienna, Austria.
Cancer. 2006 Jul 1;107(1):162-70. doi: 10.1002/cncr.21973.
Hot-spot microvessel density (MVD) and vascular patterns have been reported as histopathologic factors that influence prognosis in retrospective series of malignant gliomas. To investigate clinical utility, the authors systematically studied observer agreement on MVD and vascular patterns and the influence of repeatedly assessed data on patient outcomes in 2 independent glioblastoma series.
MVD and vascular patterns were assessed retrospectively by 5 observers in 1) a retrospectively compiled glioblastoma series that included 110 patients and 2) a glioblastoma series that included 233 patients who were treated within a randomized trial. MVD was determined in the field of greatest density ("hot-spot"). Predominantly classic or bizarre vascular patterns were determined by using a previously defined algorithm.
Observer agreement on MVD was highly variable (range of kappa values, 0.464-0.901). The worst observer agreement was achieved when both the selection of hot-spots and MVD counts were performed independently. Survival analysis did not show a consistent association between repeatedly assessed MVD and patient outcome. Observer agreement on vascular patterns was poor (kappa = 0.297). Survival analysis did not show a consistent association between repeatedly assessed vascular patterns and patient outcome.
Observer agreement on hot-spot MVD and vascular patterns in patients with glioblastoma was poor in independent assessments. MVD and vascular patterns were not associated consistently with patient outcome. Based on these findings, the authors concluded that poor observer agreement limits the clinical utility of histopathologically assessed hot-spot MVD and vascular patterns as prognostic factors in patients with glioblastoma. Improved methodologies for morphologic assessment of glioblastoma vascularization need to be identified.
在恶性胶质瘤回顾性研究系列中，热点微血管密度（MVD）和血管模式已被报道为影响预后的组织病理学因素。为了研究其临床实用性，作者在2个独立的胶质母细胞瘤系列中，系统地研究了观察者对MVD和血管模式的一致性，以及重复评估数据对患者预后的影响。
5名观察者对以下两组进行回顾性评估MVD和血管模式：1）一个回顾性汇编的胶质母细胞瘤系列，包括110例患者；2）一个胶质母细胞瘤系列，包括233例在随机试验中接受治疗的患者。在密度最大的区域（“热点”）确定MVD。使用先前定义的算法确定主要为经典或奇异的血管模式。
观察者对MVD的一致性差异很大（kappa值范围为0.464 - 0.901）。当热点选择和MVD计数均独立进行时，观察者一致性最差。生存分析未显示重复评估的MVD与患者预后之间存在一致的关联。观察者对血管模式的一致性较差（kappa = 0.297）。生存分析未显示重复评估的血管模式与患者预后之间存在一致的关联。
在独立评估中，胶质母细胞瘤患者热点MVD和血管模式的观察者一致性较差。MVD和血管模式与患者预后没有始终如一的关联。基于这些发现，作者得出结论，观察者一致性差限制了组织病理学评估的热点MVD和血管模式作为胶质母细胞瘤患者预后因素的临床实用性。需要确定改进的胶质母细胞瘤血管生成形态学评估方法。
