Krouwer H G, Davis R L, Silver P, Prados M
Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
J Neurosurg. 1991 Mar;74(3):399-406. doi: 10.3171/jns.1991.74.3.0399.
Although gemistocytic astrocytomas are considered slow-growing astrocytomas, they often behave aggressively. To clarify the biological and clinical behavior of these rare tumors, the authors retrospectively identified 59 patients with gemistocytic astrocytoma whose tumors were diagnosed and treated between June, 1976, and July, 1989. Three patients who were lost to follow-up review were excluded, as were two whose original slides could not be obtained and three whose tumors were diagnosed at recurrence or at autopsy. The pathological material of the remaining 51 patients was reviewed using two sets of histological criteria. Thirteen patients (Group A) had "pure" gemistocytic astrocytoma, defined as a glial tumor with more than 60% gemistocytes/high-power field and a background of fibrillary astrocytes. Fifteen patients (Group B) had "mixed" gemistocytic astrocytoma, defined as a glial tumor with 20% to 60% gemistocytes/high-power field and a background of anaplastic astrocytes. Twenty-three tumors did not meet these criteria and were excluded from analysis. The median age of the patients was 48.5 years in Group A and 38.3 years in Group B (p less than 0.05). In both groups, the median Karnofsky Performance Scale score was greater than 90%. All patients underwent surgical procedures (four total and 19 partial resections, and five biopsies) and postoperative radiation therapy. The majority also had interstitial brachytherapy, chemotherapy, or both. Ten patients had one reoperation for tumor recurrence and one had two reoperations; other treatments for recurrence included brachytherapy, chemotherapy, and repeat irradiation. All four patients who originally underwent gross total resection are still alive; all five who had a biopsy have died. There was no significant difference in median survival times between groups: 136.5 weeks in Group A (range 10 to 310+ weeks) and 135.6 weeks in Group B (range 31 to 460+ weeks). Analysis of all 28 patients showed a better prognosis for patients less than 50 years of age (185 vs. 36 weeks survival time; p less than 0.001), patients with preoperative symptoms lasting for more than 6 months (228.1 vs. 110.2 weeks survival time; p less than 0.05), and patients with seizures as the first symptom (185.7 vs. 80 weeks survival time; p less than 0.01). Survival time did not correlate with the presence of perivascular lymphocytic infiltration. The authors conclude that the presence of at least 20% gemistocytes in a glial neoplasm is a poor prognostic sign, irrespective of the pathological background. It is proposed that gemistocytic astrocytomas be classified with anaplastic astrocytomas and treated accordingly.
尽管肥胖型星形细胞瘤被认为是生长缓慢的星形细胞瘤，但它们往往具有侵袭性。为了阐明这些罕见肿瘤的生物学和临床行为，作者回顾性地确定了59例肥胖型星形细胞瘤患者，其肿瘤在1976年6月至1989年7月期间被诊断和治疗。3例失访患者被排除，2例无法获得原始切片的患者以及3例肿瘤在复发时或尸检时被诊断的患者也被排除。使用两组组织学标准对其余51例患者的病理材料进行了复查。13例患者（A组）患有“纯”肥胖型星形细胞瘤，定义为神经胶质肿瘤，每高倍视野中肥胖细胞超过60%，且背景为纤维性星形细胞。15例患者（B组）患有“混合”肥胖型星形细胞瘤，定义为神经胶质肿瘤，每高倍视野中肥胖细胞为20%至60%，且背景为间变性星形细胞。23个肿瘤不符合这些标准，被排除在分析之外。A组患者的中位年龄为48.5岁，B组为38.3岁（p小于0.05）。两组患者的卡氏功能状态评分中位数均大于90%。所有患者均接受了手术（4例全切、19例部分切除和5例活检）及术后放疗。大多数患者还接受了间质近距离放疗、化疗或两者兼而有之。10例患者因肿瘤复发接受了1次再次手术，1例接受了2次再次手术；其他复发治疗包括近距离放疗、化疗和重复照射。最初接受全切的4例患者均存活；5例接受活检的患者均已死亡。两组患者的中位生存时间无显著差异：A组为136.5周（范围10至310 +周），B组为135.6周（范围31至460 +周）。对所有28例患者的分析表明，年龄小于50岁的患者预后较好（生存时间为185 vs. 36周；p小于0.001），术前症状持续超过6个月的患者（生存时间为分别为228.1 vs. 110.2周；p小于0.05），以及以癫痫为首发症状的患者（生存时间为185.7 vs. 80周；p小于0.01）。生存时间与血管周围淋巴细胞浸润的存在无关。作者得出结论，神经胶质肿瘤中至少存在20%的肥胖细胞是预后不良的标志，与病理背景无关。建议将肥胖型星形细胞瘤归类为间变性星形细胞瘤并相应地进行治疗。
