Sun D Q, Feng C H, Fang J Q, Biesterfeld S, Boecking A
Bone Tumor Research Laboratory, People's Hospital, Bejing Medical University.
Chin Med J (Engl). 1991 Apr;104(4):281-7.
Clinical behavior of giant cell tumor of bone (GCT) may vary remarkably from latent to very aggressive. Quantitative pathological methods were used to evaluate the aggressiveness of GCT. Fifteen cytometric parameters were measured and computed on routine sections of 40 GCTs which had been treated with curettage. The surgery factor (with or without additional procedures like bone cement packing or freezing after the curettage) was also taken into account and computed. Nineteen of the 40 GCTs were cured and 21 recurred. While no single one from the 15 parameters measured showed significant differences between the cured and recurrent groups according to the Mann-Whitney's U test or Student's t test, a 4-variable function was established with a stepwise discriminant analysis which could correctly identify 70.8% of the predicted cases as cured or recurrent (jackknife procedure). The function also suggested that in addition to the surgery factor, which no doubt had close relation with the prognosis, the most important risk factor in histological parameters was SA40, i.e. the percent of cells with nucleus larger than 40 square microns. Single cells extracted from paraffin-embedded blocks of 38 GCTs were analyzed by DNA-image cytometry. The 2c deviation index (2cDI) showed wide heterogeneity ranging from those consistent with benign tumors to those with apparent malignant ones, which may account for its diversity in clinical behaviour. Sixteen of the 38 cases had been treated with curettage, 8 of them were cured and followed up for at least 3 years and the remaining 8 recurred. The significant difference of 2cDI between the two groups suggested that these DNA parameters are useful in evaluating the aggressiveness of GCT for the selection of an adequate treatment. Quantitative approaches appeared to be more objective and more sensitive in evaluating the aggressiveness and predicting the prognosis of GCT than the subjective grading system used before.
骨巨细胞瘤（GCT）的临床行为可能有显著差异，从潜伏性到极具侵袭性。采用定量病理学方法评估GCT的侵袭性。对40例行刮除术治疗的GCT常规切片测量并计算了15个细胞计量学参数。还考虑并计算了手术因素（刮除术后是否进行如骨水泥填充或冷冻等额外操作）。40例GCT中19例治愈，21例复发。根据Mann-Whitney U检验或Student t检验，所测量的15个参数中没有一个在治愈组和复发组之间显示出显著差异，但通过逐步判别分析建立了一个四变量函数，该函数采用留一法交叉验证程序可正确识别70.8%的预测病例为治愈或复发。该函数还表明，除了无疑与预后密切相关的手术因素外，组织学参数中最重要的危险因素是SA40，即细胞核大于40平方微米的细胞百分比。对38例GCT石蜡包埋块中提取的单细胞进行DNA图像细胞计量学分析。2c偏差指数（2cDI）显示出广泛的异质性，从与良性肿瘤一致的到明显恶性的，这可能解释了其临床行为的多样性。38例中有16例接受了刮除术治疗，其中8例治愈并随访至少3年，其余8例复发。两组之间2cDI的显著差异表明，这些DNA参数在评估GCT的侵袭性以选择合适治疗方法方面是有用的。与以前使用的主观分级系统相比，定量方法在评估GCT的侵袭性和预测预后方面似乎更客观、更敏感。
