Umesh S, Tandon A, Santosh V, Anandh B, Sampath S, Chandramouli B A, Sastry Kolluri V R
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Clin Neuropathol. 2009 Sep-Oct;28(5):362-72.
Glioblastomas are the commonest and the most malignant of all adult brain tumors, characterized by genetic instability, intratumoral histopathological variability, and unpredictable clinical behavior. The utility of tumor markers that reflect their underlying biology is becoming increasingly important with respect to patient prognostication and their potential role as molecular targets of therapy is being recognized. In this study, we aimed to identify the clinical factors and some immunohistochemical markers that could have an effect on patient survival in supratentorial glioblastomas.
We evaluated 54 cases of adult supratentorial glioblastomas operated over a span of 1 year, with respect to clinical features such as age, Karnofsky performance score (KPS), extent of resection, adjuvant therapy, and immunohistochemical expression of p53, EGFR (Epidermal Growth Factor Receptor) and PTEN (Phosphatase and Tensin homolog).
Radiotherapy and KPS at presentation were significant predictors of outcome in both univariate and multivariate analyses. Among immunohistochemical variables; loss of PTEN expression in association with over-expression of EGFR showed a trend towards poorer survival, in univariate analysis. Over-expression of EGFR and/or p53 emerged as significant predictors of poor outcome on multivariate analysis, despite failing to prognosticate on univariate analysis.
Our study shows that EGFR and p53 overexpression along with loss of PTEN expression are important adjuncts to clinical variables in prognosticating glioblastoma patients.
胶质母细胞瘤是所有成人大脑肿瘤中最常见且恶性程度最高的肿瘤，其特征为基因不稳定、肿瘤内组织病理学变异性以及不可预测的临床行为。对于患者预后而言，反映其潜在生物学特性的肿瘤标志物的作用日益重要，并且它们作为治疗分子靶点的潜在作用也正在得到认可。在本研究中，我们旨在确定可能影响幕上胶质母细胞瘤患者生存的临床因素和一些免疫组化标志物。
我们评估了在1年时间内接受手术的54例成幕上胶质母细胞瘤病例，涉及年龄、卡诺夫斯基功能状态评分（KPS）、切除范围、辅助治疗等临床特征，以及p53、表皮生长因子受体（EGFR）和第10号染色体缺失的磷酸酶及张力蛋白同源物（PTEN）的免疫组化表达情况。
在单因素和多因素分析中，放疗和就诊时的KPS均是预后的重要预测指标。在免疫组化变量中；在单因素分析中，PTEN表达缺失与EGFR过表达相关显示出预后较差的趋势。尽管在单因素分析中未能预测预后，但在多因素分析中，EGFR和/或p53过表达成为预后不良的重要预测指标。
我们的研究表明，EGFR和p53过表达以及PTEN表达缺失是胶质母细胞瘤患者预后评估中临床变量的重要辅助指标。
