Ahmadipour Y, Gembruch O, Pierscianek D, Sure U, Jabbarli R
Department of Neurosurgery, University Hospital Essen, Essen, Germany.
Department of Neurosurgery, University Hospital Essen, Essen, Germany.
Neurochirurgie. 2020 Jun;66(3):150-154. doi: 10.1016/j.neuchi.2019.12.012. Epub 2020 Apr 9.
Several parameters are known to predict the survival of glioblastoma (GB), including extent of resection and MGMT promotor methylation. Staining for glial fibrillary acidic protein (GFAP) is a common component of routine histological work-up, but its clinical utility in GB is unclear. The aim of the present study was to analyze the predictive value of quantitative GFAP measurements for survival of patients with GB.
All subjects in our institutional database of patients with primary GB who underwent surgery between 2011 and 2014 with examination of immunohistochemical staining of GFAP were included. Percentage GFAP staining was measured in 5% increments (5-100%). Univariate and multivariate analyses were performed between GFAP values and survival data. Clinically relevant cut-offs for GFAP staining were identified by receiver operating characteristic (ROC) curves.
The final cohort consisted of 272GB patients with available quantitative GFAP measurements (mean age, 62 (±11.1) years, 117 females [43%]). Overall survival was 11.4 months (±8.6). Median GFAP value was 70% (range, 5-100%). The ROC curve showed the clinically relevant cut-off for GFAP at 75% (area under the curve: 0.691). Accordingly, GB patients with GFAP≥75% presented poorer survival on Kaplan-Meier survival estimation (P=0.021). Multivariate analysis adjusted for age, extent of resection, preoperative Karnofsky performance status scale, IDH1 mutation and MGMT methylation status confirmed the independent predictive value of GFAP≥75% for overall survival (P=0.032). Finally, patients with GFAP≥75% showed significantly poorer long-term survival than those with GFAP<75%: 5.8% vs. 15.2% (P=0.0183) and 0.8% vs. 8% (P=0.0076) for 2- and 3-year survival, respectively.
Quantitative immunohistochemical assessment of GFAP staining could provide a novel biomarker for overall and especially long-term survival of patients with GB. Prospective multi-center validation of the prognostic value of GFAP for GB survival is needed.
已知有几个参数可预测胶质母细胞瘤（GB）的生存期，包括切除范围和MGMT启动子甲基化。胶质纤维酸性蛋白（GFAP）染色是常规组织学检查的常见组成部分，但其在GB中的临床应用尚不清楚。本研究的目的是分析定量GFAP测量对GB患者生存期的预测价值。
纳入我们机构数据库中2011年至2014年间接受手术并进行GFAP免疫组化染色检查的原发性GB患者。以5%的增量（5%-100%）测量GFAP染色百分比。对GFAP值和生存数据进行单因素和多因素分析。通过受试者工作特征（ROC）曲线确定GFAP染色的临床相关临界值。
最终队列包括272例可进行GFAP定量测量的GB患者（平均年龄62（±11.1）岁，117例女性[43%]）。总生存期为11.4个月（±8.6）。GFAP值中位数为70%（范围5%-100%）。ROC曲线显示GFAP的临床相关临界值为75%（曲线下面积：0.691）。因此，GFAP≥75%的GB患者在Kaplan-Meier生存估计中生存期较差（P=0.021）。对年龄、切除范围、术前卡诺夫斯基功能状态量表、异柠檬酸脱氢酶1（IDH1）突变和MGMT甲基化状态进行多因素分析后，证实GFAP≥75%对总生存期具有独立预测价值（P=0.032）。最后，GFAP≥75%的患者长期生存率明显低于GFAP<75%的患者：2年生存率分别为5.8%和15.2%（P=0.0183），3年生存率分别为0.8%和8%（P=0.0076）。
GFAP染色的定量免疫组化评估可为GB患者的总生存期尤其是长期生存期提供一种新的生物标志物。需要对GFAP对GB生存期的预后价值进行前瞻性多中心验证。
