Horta Rodrigo S, Lavalle Gleidice E, Monteiro Lidianne N, Souza Mayara C C, Cassali Geovanni D, Araújo Roberto B
1 Universidade Vila Velha, Vila Velha, ES, Brazil.
2 Department of Veterinary Clinics and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Vet Pathol. 2018 Mar;55(2):212-223. doi: 10.1177/0300985817747325. Epub 2018 Jan 16.
Mast cell tumor (MCT) is a frequent cutaneous neoplasm in dogs that is heterogeneous in clinical presentation and biological behavior, with a variable potential for recurrence and metastasis. Accurate prediction of clinical outcomes has been challenging. The study objective was to develop a system for classification of canine MCT according to the mortality risk based on individual assessment of clinical, histologic, immunohistochemical, and molecular features. The study included 149 dogs with a histologic diagnosis of cutaneous or subcutaneous MCT. By univariate analysis, MCT metastasis and related death was significantly associated with clinical stage ( P < .0001, r = -0.610), history of tumor recurrence ( P < .0001, r = -0.550), Patnaik ( P < .0001, r = -0.380) and Kiupel grades ( P < .0001, r = -0.500), predominant organization of neoplastic cells ( P < .0001, r = -0.452), mitotic count ( P < .0001, r = -0.325), Ki-67 labeling index ( P < .0001, r = -0.414), KITr pattern ( P = .02, r = 0.207), and c-KIT mutational status ( P < .0001, r = -0.356). By multivariate analysis with Cox proportional hazard model, only 2 features were independent predictors of overall survival: an amendment of the World Health Organization clinical staging system (hazard ratio [95% CI]: 1.824 [1.210-4.481]; P = .01) and a history of tumor recurrence (hazard ratio [95% CI]: 9.250 [2.158-23.268]; P < .001]. From these results, we propose an amendment of the WHO staging system, a method of risk analysis, and a suggested approach to clinical and laboratory evaluation of dogs with cutaneous MCT.
肥大细胞瘤（MCT）是犬类常见的皮肤肿瘤，其临床表现和生物学行为具有异质性，复发和转移的可能性各不相同。准确预测临床结果一直具有挑战性。本研究的目的是基于对临床、组织学、免疫组化和分子特征的个体评估，开发一种根据死亡风险对犬MCT进行分类的系统。该研究纳入了149只经组织学诊断为皮肤或皮下MCT的犬。通过单因素分析，MCT转移及相关死亡与临床分期（P <.0001，r = -0.610）、肿瘤复发史（P <.0001，r = -0.550）、帕特奈克（P <.0001，r = -0.380）和基佩尔分级（P <.0001，r = -0.500）、肿瘤细胞的主要组织学类型（P <.0001，r = -0.452）、有丝分裂计数（P <.0001，r = -0.325）、Ki-67标记指数（P <.0001，r = -0.414）、KITr模式（P =.02，r = 0.207）以及c-KIT突变状态（P <.0001，r = -0.356）显著相关。通过Cox比例风险模型进行多因素分析，只有2个特征是总生存的独立预测因素：世界卫生组织临床分期系统的修正版（风险比[95%CI]：1.824[1.210 - 4.481]；P =.01）和肿瘤复发史（风险比[95%CI]：9.250[2.158 - 23.268]；P <.001]。基于这些结果，我们提出了世界卫生组织分期系统的修正版、一种风险分析方法以及对患有皮肤MCT犬的临床和实验室评估的建议方法。
