Tohyama T, Kubo O, Katahira M, Sakairi M, Tajika T, Tajika Y, Kitamura K
Department of Neurosurgery, Tokyo Women's Medical College, Japan.
No Shinkei Geka. 1988 Oct;16(11):1243-50.
Medulloblastoma is the most common primitive neuroectodermal tumor (PNET) with the potential to differentiate along glial or neuronal lines. Thirty cases of medulloblastoma were tested by the peroxidase-antiperoxidase (PAP) method with anti-GFAP serum (DAKO) and by the avidin-biotin peroxidase complex (ABC) method with 68kd subunit of anti-NF antibody. All the cases were classified into three subtypes based on these immunohistochemical findings and were analyzed in relation to clinico-pathological features. Fifteen of thirty medulloblastomas contained GFAP positive cells, seventeen showed cells reacting to NF. The reactions for both proteins were present in eight medulloblastomas (PNET-BD, bipotential differentiation). Seventeen medulloblastomas reacted to only one protein (PNET-MD, monopotential differentiation). No reaction for either was found in five cases (PNET-NOS, not otherwise specified). The two year survival rate was 12.5% for PNET-BD compared to 49.2% for PNET-MD and 53.3% for PNET-NOS. Nine variables, i.e. age, tumor stage, metastatic stage, operation, radiotherapy, chemotherapy, histology, GFAP and NF, were analyzed using Cox's proportional hazard model. This revealed that the significant factors were tumor stage (p = 0.0002), GFAP (p = 0.0008) and operation (p less than 0.05). In conclusion, GFAP is the most important histological factor for prognosis and medulloblastoma without glial differentiation has a much better prognosis than one with glial differentiation.
髓母细胞瘤是最常见的原始神经外胚层肿瘤（PNET），有沿神经胶质或神经元方向分化的潜能。采用抗GFAP血清（DAKO）的过氧化物酶-抗过氧化物酶（PAP）法和抗NF抗体68kd亚基的抗生物素蛋白-生物素过氧化物酶复合物（ABC）法对30例髓母细胞瘤进行检测。根据这些免疫组化结果，将所有病例分为三个亚型，并结合临床病理特征进行分析。30例髓母细胞瘤中，15例含有GFAP阳性细胞，17例显示对NF有反应的细胞。8例髓母细胞瘤（PNET-BD，双潜能分化）对两种蛋白均有反应。17例髓母细胞瘤仅对一种蛋白有反应（PNET-MD，单潜能分化）。5例未发现对任何一种蛋白有反应（PNET-NOS，未另行指定）。PNET-BD的两年生存率为12.5%，而PNET-MD为49.2%，PNET-NOS为53.3%。使用Cox比例风险模型分析了九个变量，即年龄、肿瘤分期、转移分期、手术、放疗、化疗、组织学、GFAP和NF。结果显示，显著因素为肿瘤分期（p = 0.0002）、GFAP（p = 0.0008）和手术（p < 0.05）。总之，GFAP是预后最重要的组织学因素，无神经胶质分化的髓母细胞瘤预后比有神经胶质分化的髓母细胞瘤好得多。
