¹¹C-蛋氨酸摄取和术中 5-氨基乙酰丙酸诱导的荧光作为胶质瘤细胞密度的独立指标标记物：一项立体定向图像-组织学分析。

¹¹C-methionine uptake and intraoperative 5-aminolevulinic acid-induced fluorescence as separate index markers of cell density in glioma: a stereotactic image-histological analysis.

机构信息

Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.

出版信息

Cancer. 2012 Mar 15;118(6):1619-27. doi: 10.1002/cncr.26445. Epub 2011 Aug 11.

DOI:10.1002/cncr.26445

PMID:21837671

Abstract

BACKGROUND

The extent of tumor resection is acknowledged as 1 of the prognostic factors for glioma. 5-Aminolevulinic acid (5-ALA)-induced fluorescence guidance and neuronavigation integrated with (11) C-methionine positron emission tomography (PET) are widely utilized under the expectation of improving the extent of resection. These 2 novel approaches are beneficial for glioma resections, and the combination of these approaches appears rational. However, biological characteristics reflecting 5-ALA-induced fluorescence and (11) C-methionine uptake have not been clearly elucidated, and studies about the relationship between 5-ALA-induced fluorescence and (11) C-methionine uptake have been limited. The present study aimed to clarify this issue.

METHODS

Data from 11 consecutive patients harboring astrocytic tumors were analyzed: 2 grade II and 2 grade III, and 7 grade IV tumors were included. Thirty samples from these patients were obtained from the relative periphery of each tumor. Relationships among histology, 5-ALA-induced fluorescence and (11) C-methionine uptake were analyzed by stereotactic sampling and image analysis.

RESULTS

Uptake of (11) C-methionine correlated with cell density (R(2) = 0.322, P = .0059). Cell density was higher in fluorescence-positive areas than in negative areas (2760 ± 1080 vs 1450 ± 1380/mm(2) , P = .0132). Although both (11) C-methionine uptake and fluorescence seemed to correlate with cell density, no significant difference in (11) C-methionine uptake was seen between fluorescence-positive and -negative areas (P = .367). Multiple linear regression analysis revealed (11) C-methionine uptake and 5-ALA-induced fluorescence as independent indices for tumor cell density.

CONCLUSIONS

These results indicate that 5-ALA fluorescence and (11) C-methionine PET image are separate index markers for cytoreduction surgery of gliomas.

摘要

背景

肿瘤切除范围被认为是影响神经胶质瘤预后的因素之一。5-氨基酮戊酸（5-ALA）诱导荧光引导和神经导航与（11）C-蛋氨酸正电子发射断层扫描（PET）相结合，被广泛应用于提高切除范围。这两种新方法有利于神经胶质瘤切除术，并且联合应用这两种方法是合理的。然而，反映 5-ALA 诱导荧光和（11）C-蛋氨酸摄取的生物学特性尚未明确阐明，并且关于 5-ALA 诱导荧光与（11）C-蛋氨酸摄取之间关系的研究也有限。本研究旨在阐明这一问题。

方法

对 11 例连续存在星形细胞瘤的患者的数据进行了分析：包括 2 例 II 级和 2 例 III 级，7 例 IV 级肿瘤。从这些患者中获得了 30 个肿瘤样本。通过立体定向取样和图像分析，分析组织学、5-ALA 诱导荧光和（11）C-蛋氨酸摄取之间的关系。

结果

（11）C-蛋氨酸摄取与细胞密度相关（R2=0.322，P=0.0059）。荧光阳性区域的细胞密度高于阴性区域（2760±1080 vs 1450±1380/mm2，P=0.0132）。尽管（11）C-蛋氨酸摄取和荧光似乎都与细胞密度相关，但在荧光阳性和阴性区域之间，（11）C-蛋氨酸摄取没有显著差异（P=0.367）。多元线性回归分析显示，（11）C-蛋氨酸摄取和 5-ALA 诱导荧光是肿瘤细胞密度的独立指标。