Ekmekci Sümeyye, Olgun Nur, Özer Erdener
Department of Pathology, Dokuz Eylul University, School of Medicine, İZMİR, TURKEY.
Turk Patoloji Derg. 2016;32(2):99-104. doi: 10.5146/tjpath.2015.01348.
Prognostic parameters in determining risk groups for treatment in neuroblastoma are cellular differentiation, mitosis karyorrhexis index (MKI), N-myc amplification and age. However, additional prognosticators are still needed because patients can show unpredictable biological behavior. We aimed to study the prognostic significance of apoptotic activity in neuroblastomas.
Thirty-five primary neuroblastoma were evaluated. The data including stage, treatment protocol, metastatic disease, survival, N-myc status, age and prognostic categorization were obtained from the clinical records. The differentiation and MKI were evaluated in hematoxylin and eosin stained slides. Apoptotic activity was assessed by both bcl-2 immunohistochemical staining and the transferase-mediated d-UTP-biotin nick end labeling (TUNEL) method. Data were correlated with established prognostic factors and clinical outcome.
Twenty-five (71.4%) cases were located in the adrenal. Sixteen cases showed low and 19 high MKI. Thirty-three (%94) were immunopositive for bcl-2. TUNEL staining was negative in 2 cases. Of the remaining positive 33 cases, 14 had an apoptotic index of ≤2%, 11 of 2-4% and 8 of ≥4%. Cases located in the adrenal showed higher scores of bcl-2 positivity than extra-adrenal tumors. There was no statistical significance for both bcl-2 staining and apoptotic index in correlation with cellular differentiation, MKI, N-myc amplification, age and other clinical parameters. Statistical significance was observed between bcl-2 scoring and tumor localization.
According to our results, apoptotic activity is unlikely to be a prognostic parameter in neuroblastomas. Some studies showing significant correlations between clinical outcome and both bcl-2 immunoscoring and apoptotic index, as assessed by the TUNEL method, differences in case numbers and methodology can explain these conflicting results. Larger series and different methodologies are needed to evaluate the prognostic value of apoptotic activity in neuroblastomas.
神经母细胞瘤治疗风险分组的预后参数包括细胞分化、有丝分裂核溶解指数（MKI）、N - myc扩增和年龄。然而，由于患者可能表现出不可预测的生物学行为，仍需要其他预后指标。我们旨在研究凋亡活性在神经母细胞瘤中的预后意义。
评估了35例原发性神经母细胞瘤。从临床记录中获取了包括分期、治疗方案、转移性疾病、生存情况、N - myc状态、年龄和预后分类等数据。在苏木精和伊红染色的切片上评估分化程度和MKI。通过bcl - 2免疫组织化学染色和转移酶介导的d - UTP - 生物素缺口末端标记（TUNEL）法评估凋亡活性。将数据与已确定的预后因素和临床结果进行关联分析。
25例（71.4%）位于肾上腺。16例MKI低，19例MKI高。33例（94%）bcl - 2免疫阳性。2例TUNEL染色阴性。其余33例阳性病例中，14例凋亡指数≤2%，11例为2 - 4%，8例≥4%。位于肾上腺的病例bcl - 2阳性评分高于肾上腺外肿瘤。bcl - 2染色和凋亡指数与细胞分化、MKI、N - myc扩增、年龄及其他临床参数之间均无统计学意义。bcl - 2评分与肿瘤定位之间存在统计学意义。
根据我们的结果，凋亡活性不太可能是神经母细胞瘤的预后参数。一些研究表明临床结果与bcl - 2免疫评分及TUNEL法评估的凋亡指数之间存在显著相关性，病例数量和方法学的差异可以解释这些相互矛盾的结果。需要更大规模的系列研究和不同的方法来评估凋亡活性在神经母细胞瘤中的预后价值。
