幕上胶质母细胞瘤中增强结节与 FLAIR 高信号之间的癌症干细胞解剖分布:是否需要重新校准手术靶区?

Anatomical distribution of cancer stem cells between enhancing nodule and FLAIR hyperintensity in supratentorial glioblastoma: time to recalibrate the surgical target?

机构信息

Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Viale Carlo Azeglio CIampi, 1, 95121, Catania, Italy.

Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy.

出版信息

Neurosurg Rev. 2022 Dec;45(6):3709-3716. doi: 10.1007/s10143-022-01863-8. Epub 2022 Sep 28.

Abstract

It is ge nerally accepted that glioblastoma (GBM) arise from cancer stem cells (CSC); however, there is little evidence on their anatomical distribution. We investigated the expression and distribution of SOX-2-positive and CD133-positive CSCs both in the enhancing nodule (EN) of GBM and in the FLAIR hyperintensity zones on a surgical, histopathological series of 33 GBMs. The inclusion criterion was the intraoperative sampling of different tumor regions individualized, thanks to neuronavigation and positivity to intraoperative fluorescence with the use of 5-aminolevulinic acid (5-ALA). Thirty-three patients (20 males and 13 females with a mean age at diagnosis of 56 years) met the inclusion criterion. A total of 109 histological samples were evaluated, 52 for ENs and 57 for FLAIR hyperintensity zone. Considering the quantitative distribution of levels of intensity of staining (IS), ES (extent score), and immunoreactivity score (IRS), no difference was found between ENs and FLAIR regions for both the SOX-2 biomarker (respectively, IS p = 0.851, ES p = 0.561, IRS p = 1.000) and the CD133 biomarker (IS p = 0.653, ES p = 0.409, IRS p = 0.881). This evidence suggests to recalibrate the target of surgery for FLAIRECTOMY and 5-ALA could improve the possibility to achieve this goal.

摘要

人们普遍认为胶质母细胞瘤(GBM)源自癌症干细胞(CSC);然而,关于它们的解剖分布,证据很少。我们研究了 SOX-2 阳性和 CD133 阳性 CSC 在 GBM 的增强结节(EN)和手术、组织病理学系列的 33 例 GBM 的 FLAIR 高信号区中的表达和分布。纳入标准是术中对不同肿瘤区域进行个体化采样,这要归功于神经导航和使用 5-氨基乙酰丙酸(5-ALA)进行术中荧光的阳性。33 名患者(20 名男性和 13 名女性,平均诊断年龄为 56 岁)符合纳入标准。共评估了 109 个组织学样本,52 个用于 EN,57 个用于 FLAIR 高信号区。考虑到染色强度(IS)、扩展评分(ES)和免疫反应评分(IRS)的定量分布,在 SOX-2 生物标志物(分别为 IS p=0.851,ES p=0.561,IRS p=1.000)和 CD133 生物标志物方面,EN 和 FLAIR 区域之间没有差异(IS p=0.653,ES p=0.409,IRS p=0.881)。这一证据表明需要重新校准 FLAIRECTOMY 的手术目标,而 5-ALA 可以提高实现这一目标的可能性。

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