Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Department of Neurosurgery, Universidad de Navarra Facultad de Medicina, Pamplona, Navarra, Spain.
J Neurol Surg A Cent Eur Neurosurg. 2021 Jan;82(1):53-58. doi: 10.1055/s-0040-1709730. Epub 2020 Dec 1.
The infiltrative margin of glioblastomas (GBM) contains proliferative tumor cells difficult to estimate radiologically as they are included in the hyperintense signal of T2 sequences and they remain in the cavity margin after tumor resection. The amount of these cells could determine overall survival (OS) of these patients.
From October 2007 to January 2010, patients whose MRI were suggestive of newly diagnosed, resectable high-grade glioma were operated using fluorescence-guided surgery (FGS). Separate samples were selectively taken from nonfluorescent white matter areas just adjacent to the border of the pale fluorescence and staining was made for Ki-67. OS was analyzed with Kaplan-Meier and Cox regression. Multivariate analysis included the following prognosis variables: age, extent of resection (EOR), O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, and performance status index.
Sample included 65 patients, comprising 37 men and 28 women, with a median Karnofsky Performance Score (KPS) of 80 (40-100) and mean age of 60 (34-78) years. Mean preoperative tumor volume was 35.8 mL. EOR was 100% in 52 patients (80%), with the lower EOR being 88%. For Ki-67, 39 patients had <5% and 26 had ≥5%. OS was 26.8 months (95% confidence interval [CI]: 18.9-28.2) for the Ki-67 low group versus 15.8 months (95% CI: 7.7-18.2) for the Ki-67 high group ( = 0.002).
Proliferative activity in the normal-looking brain around the resection cavity measured with Ki-67 immunostaining is an important independent prognostic factor for GBM cases with complete resection of enhancing tumor. When complete resection is not reached, this factor is not relevant for prognosis.
胶质母细胞瘤（GBM）的浸润边缘包含增殖性肿瘤细胞，由于它们包含在 T2 序列的高信号中，并且在肿瘤切除后仍留在腔边缘，因此很难在影像学上估计。这些细胞的数量可能决定这些患者的总生存期（OS）。
从 2007 年 10 月至 2010 年 1 月，对 MRI 提示新诊断、可切除高级别胶质瘤的患者，采用荧光引导手术（FGS）进行手术。从紧邻苍白荧光边界的非荧光白质区域选择性采集单独样本，并对 Ki-67 进行染色。采用 Kaplan-Meier 和 Cox 回归分析 OS。多变量分析包括以下预后变量：年龄、切除程度（EOR）、O-6-甲基鸟嘌呤-DNA 甲基转移酶（MGMT）启动子甲基化和表现状态指数。
样本包括 65 例患者，其中 37 例为男性，28 例为女性，Karnofsky 表现状态评分（KPS）中位数为 80（40-100），平均年龄为 60（34-78）岁。术前肿瘤平均体积为 35.8ml。52 例患者（80%）EOR 为 100%，EOR 较低的为 88%。Ki-67 中，39 例<5%，26 例≥5%。Ki-67 低组的 OS 为 26.8 个月（95%置信区间[CI]：18.9-28.2），Ki-67 高组的 OS 为 15.8 个月（95%CI：7.7-18.2）（ = 0.002）。
用 Ki-67 免疫染色测量切除腔周围正常外观脑组织中的增殖活性是增强肿瘤完全切除后胶质母细胞瘤病例的重要独立预后因素。当未达到完全切除时，该因素与预后无关。
