Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, China.
J Neurol Neurosurg Psychiatry. 2016 Apr;87(4):386-95. doi: 10.1136/jnnp-2014-309805. Epub 2015 Apr 24.
Optimal grading and treatment of pineal parenchymal tumours of intermediate differentiation (PPTID) have not been established due to their rarity. After careful review of more than 500 pineal region tumours treated in our centre, 27 patients with PPTID were identified.
Diagnoses were confirmed according to WHO classification and graded as suggested by Jouvet et al. The relationship between the WHO grade, histopathological characters, management and outcome was analysed.
The WHO grade did not demonstrate significant correlation with outcome. Mitotic count and Ki-67 labelling index (LI) were detected as prognostic factors. Stratification of patients by mitotic count and Ki-67 LI correlated significantly with overall survival and progression-free survival. All the patients underwent resection. Gross total resection (GTR) was achieved in 16/27 (59.3%) patients, subtotal resection in 6/27 (22.2%) patients and partial resection in 5/27 (18.5%) patients. Log rank test confirmed GTR correlated with significantly better survival. Adjuvant therapy had a tendency to correlate significantly with progression-free survival. Among the high-risk patients, 6/9 patients with residual tumour received radiotherapy and 50% (3/6) were free of local tumour recurrence. In the other three high-risk patients with residual tumour who did not receive adjuvant therapy, recurrence occurred early and Ki-67 LI predicted prognosis.
Risk evaluation combining mitotic count and Ki-67 LI predicts prognosis. Surgery is the most efficient management. GTR is related to better prognosis. If GTR is not achieved, adjuvant therapy might delay tumour progression or recurrence, especially in high-risk patients.
由于松果体实质肿瘤中间分化型（PPTID）较为罕见，其最佳分级和治疗方法尚未确定。在仔细回顾了我们中心治疗的 500 多个松果体区域肿瘤后，确定了 27 例 PPTID 患者。
根据世界卫生组织（WHO）分类和 Jouvet 等人的建议进行诊断和分级。分析了 WHO 分级、组织病理学特征、治疗方法和预后之间的关系。
WHO 分级与预后无显著相关性。有丝分裂计数和 Ki-67 标记指数（LI）被检测为预后因素。患者的分层通过有丝分裂计数和 Ki-67 LI 与总生存和无进展生存显著相关。所有患者均接受了手术切除。27 例患者中，16 例（59.3%）实现了大体全切除（GTR），6 例（22.2%）实现了次全切除，5 例（18.5%）实现了部分切除。对数秩检验证实 GTR 与生存率显著相关。辅助治疗与无进展生存率有显著相关性。在高风险患者中，9 例有残留肿瘤的患者中有 6 例接受了放疗，其中 50%（3/6）无局部肿瘤复发。在另外 3 例未接受辅助治疗的高风险残留肿瘤患者中，复发较早，Ki-67 LI 预测了预后。
结合有丝分裂计数和 Ki-67 LI 的风险评估预测预后。手术是最有效的治疗方法。GTR 与更好的预后相关。如果不能实现 GTR，辅助治疗可能会延迟肿瘤进展或复发，尤其是在高风险患者中。
