Takano Shingo, Ishikawa Eiichi, Sakamoto Noriaki, Matsuda Masahide, Akutsu Hiroyoshi, Noguchi Masayuki, Kato Yukinari, Yamamoto Tetsuya, Matsumura Akira
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Pathology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Brain Tumor Pathol. 2016 Apr;33(2):107-16. doi: 10.1007/s10014-016-0260-x. Epub 2016 Mar 11.
The molecular subgrouping of diffuse gliomas was recently found to stratify patients into prognostically distinct groups better than histological classification. Among several molecular parameters, the key molecules for the subtype diagnosis of diffuse gliomas are IDH mutation, 1p/19q co-deletion, and ATRX mutation; 1p/19q co-deletion is undetectable by immunohistochemistry, but is mutually exclusive with ATRX and p53 mutation in IDH mutant gliomas. Therefore, we applied ATRX and p53 immunohistochemistry instead of 1p/19q co-deletion analysis. The prognostic value of immunohistochemical diagnosis for Grade III gliomas was subsequently investigated. Then, the same immunohistochmical diagnostic approach was expanded for the evaluation of Grade II and IV diffuse glioma prognosis. The results indicate immunohistochemical analysis including IDH1/2, ATRX, p53, and Ki-67 index is valuable for the classification of diffuse gliomas, which is useful for the evaluation of prognosis, especially Grade III gliomas and lower-grade gliomas (i.e., Grade II and III).
最近发现，弥漫性胶质瘤的分子亚组分类比组织学分类能更好地将患者分层为预后不同的组。在几个分子参数中，弥漫性胶质瘤亚型诊断的关键分子是异柠檬酸脱氢酶（IDH）突变、1p/19q共缺失和α地中海贫血/智力发育迟缓综合征X连锁基因（ATRX）突变；1p/19q共缺失无法通过免疫组织化学检测到，但在IDH突变型胶质瘤中与ATRX和p53突变相互排斥。因此，我们应用了ATRX和p53免疫组织化学检测，而非1p/19q共缺失分析。随后研究了免疫组织化学诊断对III级胶质瘤的预后价值。然后，将相同的免疫组织化学诊断方法扩展用于评估II级和IV级弥漫性胶质瘤的预后。结果表明，包括异柠檬酸脱氢酶1/2（IDH1/2）、ATRX、p53和Ki-67指数在内的免疫组织化学分析对弥漫性胶质瘤的分类有价值，这有助于预后评估，尤其是对III级胶质瘤和低级别胶质瘤（即II级和III级）。
