Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China.
Neuro Oncol. 2012 Apr;14(4):518-25. doi: 10.1093/neuonc/nor232. Epub 2012 Feb 10.
Glioblastomas (GBMs) containing foci that resemble oligodendroglioma are defined as GBM with oligodendroglioma component (GBMO). However, whether GBMO is a distinct clinicopathological variant of GBM or merely represents a divergent pattern of differentiation remains controversial. We investigated 219 consecutive primary GBMs, of which 40 (18.3%) were confirmed as GBMOs. The clinical features and genetic profiles of the GBMOs were analyzed and compared with the conventional GBMs. The GBMO group showed more frequent tumor-related seizures (P= .027), higher frequency of IDH1 mutation (31% vs. <5%, P= .015), lower MGMT expression (P= .016), and longer survival (19.0 vs. 13.2 months; P= .022). In multivariate Cox regression analyses, presence of an oligodendroglioma component was predictive of longer survival (P= .001), but the extent of the oligodendroglial component appeared not to be linked to prognosis (P= .664). The codeletions of 1p/19q, somewhat surprisingly, were infrequent (<5%) in both GBMO and conventional GBM. In addition, the response to aggressive therapy differed: the GBMO group had no survival advantage associated with aggressive treatment protocols, whereas a clear treatment effect was observed in the conventional GBM group. Collectively, the clinical behavior and genetic alterations of GBMO thus differs from those of conventional GBM. Presence of an oligodendroglial component may therefore be a useful classification and stratification variable in therapeutic trials of GBMs.
含有类似于少突胶质细胞瘤病灶的胶质母细胞瘤被定义为含有少突胶质细胞瘤成分的胶质母细胞瘤（GBMO）。然而，GBMO 是否是胶质母细胞瘤的一种独特的临床病理变异，还是仅仅代表了一种不同的分化模式，仍然存在争议。我们研究了 219 例连续的原发性胶质母细胞瘤，其中 40 例（18.3%）被确认为 GBMO。分析了 GBMO 的临床特征和遗传特征，并与传统的胶质母细胞瘤进行了比较。GBMO 组表现出更频繁的肿瘤相关性癫痫发作（P=.027），更高的 IDH1 突变频率（31%比<5%，P=.015），更低的 MGMT 表达（P=.016）和更长的生存时间（19.0 比 13.2 个月；P=.022）。在多变量 Cox 回归分析中，存在少突胶质细胞瘤成分是生存时间延长的预测因素（P=.001），但少突胶质成分的程度似乎与预后无关（P=.664）。出乎意料的是，1p/19q 的缺失在 GBMO 和传统胶质母细胞瘤中都很少见（<5%）。此外，侵袭性治疗的反应不同：GBMO 组没有与积极治疗方案相关的生存优势，而在传统胶质母细胞瘤组中观察到了明显的治疗效果。总的来说，GBMO 的临床行为和遗传改变与传统胶质母细胞瘤不同。因此，少突胶质成分的存在可能是胶质母细胞瘤治疗试验中有用的分类和分层变量。
