Tu Albert, Robison Aaron, Melamed Edward, Buchanan Ian, Hariri Omid, Babu Harish, Szymanski Linda, Krieger Mark
Children's Minnesota, St. Paul, Minnesota, USA,
Children's Hospital LA, Los Angeles, California, USA.
Pediatr Neurosurg. 2018;53(6):395-400. doi: 10.1159/000490466. Epub 2018 Nov 14.
BACKGROUND/AIMS: Pilocytic astrocytomas are common pediatric tumors. Molecular profiles vary with location of origin. Comparisons of proliferation have not been reported. We sought to identify differences in growth by region and whether these predict clinical behavior.
A retrospective review of all patients undergoing surgery for a pilocytic astrocytoma at Children's Hospital LA from 2003 to 2015 was completed. Tumor location, determined by imaging, was stratified into infratentorial, supratentorial, or optic pathway. Proliferation was measured by Ki-67 immunostaining. A p value of 0.05 was deemed significant.
77 patients were identified. 51 had posterior fossa tumors, 12 had supratentorial tumors, and 14 had optic pathway tumors. Mean Ki-67 score was 3.67, 4.09, and 3.83%, respectively (p = 0.82). Ki-67 of ≥4% trended towards recurrence (p = 0.11), incomplete resection (p = 0.15), and younger age at presentation (p = 0.04). Ki-67 was weakly correlated with shorter survival after surgery (r = -0.103, p = 0.41). Partial resection strongest predicted recurrence (p < 0.001; OR = 13.0).
Proliferative index does not change by location. Higher cell proliferation was seen in younger patients and associated with shorter time to and a higher risk of recurrence. Further study is needed to identify predictors for clinical behavior. Importance of Study: This study provides a detailed analysis of the proliferative indices of tumors arising from characteristic locations within the brain. With recent advances in our understanding of the differences in molecular and genetic profiles despite similar histologic diagnoses, we felt that it was important to review whether there were unique components of tumor behavior that could be identified. In turn, we sought to determine whether tumor behavior could be used to predict the clinical course. This knowledge is important, given that not every tumor may undergo complete surgical resection, and that some lesions may require more aggressive upfront adjuvant therapy or be closely monitored for recurrence.
背景/目的：毛细胞型星形细胞瘤是常见的儿科肿瘤。分子特征因起源部位而异。尚未有关于增殖情况比较的报道。我们试图确定不同区域的生长差异以及这些差异是否能预测临床行为。
对2003年至2015年在洛杉矶儿童医院接受毛细胞型星形细胞瘤手术的所有患者进行回顾性研究。通过影像学确定肿瘤位置，分为幕下、幕上或视路。通过Ki-67免疫染色测量增殖情况。p值为0.05被视为具有统计学意义。
共纳入77例患者。51例为后颅窝肿瘤，12例为幕上肿瘤，14例为视路肿瘤。平均Ki-67评分分别为3.67%、4.09%和3.83%（p = 0.82）。Ki-67≥4%有复发倾向（p = 0.11）、不完全切除倾向（p = 0.15）以及发病年龄较小倾向（p = 0.04）。Ki-67与术后生存期较短呈弱相关（r = -0.103，p = 0.41）。部分切除对复发的预测作用最强（p < 0.001；OR = 13.0）。
增殖指数不因位置而改变。年轻患者的细胞增殖较高，且与复发时间缩短和复发风险增加相关。需要进一步研究以确定临床行为的预测因素。研究的重要性：本研究对起源于脑内特征性部位的肿瘤增殖指数进行了详细分析。鉴于尽管组织学诊断相似，但我们对分子和基因特征差异的理解有了新进展，我们认为审查是否存在可识别的肿瘤行为独特成分很重要。相应地，我们试图确定肿瘤行为是否可用于预测临床病程。鉴于并非每个肿瘤都能进行完全手术切除，且一些病变可能需要更积极的 upfront 辅助治疗或密切监测复发情况，这一知识很重要。
