Smith Sarah F, Simpson Judy M, Brewer Janice A, Sekhon Lali H S, Biggs Michael T, Cook Raymond J, Little Nicholas S
Department of Neurosurgery, Royal North Shore Hospital, St. Leonards, NSW, and School of Public Health, University of Sydney, Australia, 2065.
J Neurooncol. 2006 Oct;80(1):75-82. doi: 10.1007/s11060-006-9158-5. Epub 2006 Jun 23.
Accurate prognosis for patients with anaplastic oligodendroglial gliomas is increasingly difficult to make. Characterisation of these tumours remains challenging, increasing proportions of oligodendroglial diagnoses in gliomas are reported, and no WHO 2000 grade IV exists for them, so that highly anaplastic tumours can only be grouped with glioblastoma (GBM) or with grade III oligodendroglioma, which have differing clinical behaviour. Longer survival times reported for patients with glioblastoma containing an oligodendroglial element (GBMO) suggest that a grade IV for oligodendroglial tumours might exist. In patients with anaplastic gliomas containing an oligodendroglial element, we explored whether microvascular proliferation (MVP) and necrosis were associated with shorter survival, sufficient to create a grade IV. Biopsies for 98 patients with anaplastic oligodendroglioma, anaplastic oligoastrocytoma or tumours with an oligodendroglial and GBM element, discharged 1998-2004, were identified from databases at three allied neurosurgery units. Pathology reports were reviewed for the presence of MVP and necrosis. Anaplastic oligoastrocytoma and GBMO were combined to measure the effect of an astrocytic element on survival. For anaplastic oligodendroglioma patients, median survival time was 24 months, while for anaplastic oligoastrocytoma or GBMO patients, it was 9 months. Age 60 or over (P=0.006) and astrocytic element (P=0.01) were the only independent predictors of survival. Patients 60 and over with an astrocytic element had 4.6 times the risk of death of patients under 60 with anaplastic oligodendroglioma.A grade IV cannot be created using necrosis or MVP since neither feature predicted survival after adjustment for age and an astrocytic element. However age and an astrocytic element were strong predictors of poorer survival in patients with anaplastic oligodendroglial tumours.
对间变性少突胶质细胞瘤患者进行准确的预后评估越来越困难。对这些肿瘤的特征描述仍然具有挑战性，胶质瘤中少突胶质细胞瘤诊断的比例不断增加，并且世界卫生组织2000年分类中不存在IV级的少突胶质细胞瘤，因此高度间变性肿瘤只能归类为胶质母细胞瘤（GBM）或III级少突胶质细胞瘤，而它们具有不同的临床行为。报告显示，含有少突胶质细胞成分的胶质母细胞瘤（GBMO）患者的生存时间更长，这表明可能存在IV级少突胶质细胞瘤。在含有少突胶质细胞成分的间变性胶质瘤患者中，我们探讨了微血管增殖（MVP）和坏死是否与较短的生存期相关，是否足以构成IV级。从三个联合神经外科单位的数据库中识别出1998年至2004年出院的98例间变性少突胶质细胞瘤、间变性少突星形细胞瘤或含有少突胶质细胞和GBM成分的肿瘤患者的活检样本。审查病理报告以确定是否存在MVP和坏死。将间变性少突星形细胞瘤和GBMO合并以测量星形细胞成分对生存的影响。间变性少突胶质细胞瘤患者的中位生存时间为24个月，而间变性少突星形细胞瘤或GBMO患者的中位生存时间为9个月。年龄60岁及以上（P=0.006）和星形细胞成分（P=0.01）是生存的唯一独立预测因素。60岁及以上且含有星形细胞成分的患者死亡风险是60岁以下间变性少突胶质细胞瘤患者的4.6倍。由于在调整年龄和星形细胞成分后，坏死或MVP均不能预测生存，因此不能使用坏死或MVP来划分IV级。然而，年龄和星形细胞成分是间变性少突胶质细胞瘤患者生存较差的有力预测因素。
