Schoedel K E, Martinez A J, Mahoney T M, Contis L, Becich M J
Department of Pathology, Presbyterian University Hospital, University of Pittsburgh Medical Center, PA 15213, USA.
Acta Neuropathol. 1995;89(2):139-43. doi: 10.1007/BF00296357.
Chordomas are slow growing malignant neoplasms with a prolonged clinical course which do not usually metastasize. They are histologically benign, locally invasive and often recur following resection. Survival has been shown to vary widely and prognostic indicators have been difficult to identify. Cellularity, mitotic activity and cellular pleomorphism have not been found to have prognostic significance. Thirty-six cases of clival, cervico-thoracic and sacral chordomas were evaluated utilizing four variables as possible predictors of survival: (1) silver nucleolar organizing region (AgNOR), (2) ploidy, (3) fibrosis, and (4) inflammatory response. AgNOR areas in approximately 200 cells per case were calculated and summed. DNA ploidy was obtained in 23 of the cases by analyzing deparaffinized Feulgen-stained tissue. Fibrosis and inflammation were evaluated by hematoxylin and eosin and by trichrome stains. Clinical follow-up was available in the 36 cases with survival ranging from 0.5 to 159 months. A statistical analysis employing the Cox-Proportional Hazards model disclosed no significant correlation between AgNOR area and clinical outcome (P > 0.05). The variables, fibrosis, and inflammation, did not demonstrate prognostic significance (P > 0.05). Ploidy demonstrated a statistical trend for prognostic significance (P = 0.077). It is apparent that three of the four parameters studied do not independently affect survival. Although AgNOR has proved useful in the study of other neoplasms such as those of breast, prostate and bladder, it is not of significant importance in predicting the behaviour of chordomas. Ploidy, on the other hand, may be of value in predicting clinical outcome in chordomas and may be a useful marker in the evaluation of the aggressive biological behavior of these neoplasms.
脊索瘤是一种生长缓慢的恶性肿瘤，临床病程较长，通常不发生转移。它们在组织学上是良性的，但具有局部侵袭性，切除后常复发。已表明生存率差异很大，且难以确定预后指标。未发现细胞密度、有丝分裂活性和细胞多形性具有预后意义。利用四个变量作为可能的生存预测指标，对36例斜坡、颈胸段和骶骨脊索瘤进行了评估：（1）银染核仁组织区（AgNOR），（2）倍体，（3）纤维化，以及（4）炎症反应。计算并汇总每例约200个细胞的AgNOR面积。通过分析脱蜡的福尔根染色组织，在23例病例中获得了DNA倍体。通过苏木精和伊红染色以及三色染色评估纤维化和炎症。36例患者有临床随访资料，生存期为0.5至159个月。采用Cox比例风险模型进行的统计分析显示，AgNOR面积与临床结果之间无显著相关性（P>0.05）。纤维化和炎症变量未显示出预后意义（P>0.05）。倍体显示出具有预后意义的统计趋势（P=0.077）。显然，所研究的四个参数中的三个并不能独立影响生存。尽管AgNOR已被证明在研究其他肿瘤如乳腺癌、前列腺癌和膀胱癌中有用，但在预测脊索瘤的行为方面并不重要。另一方面，倍体可能在预测脊索瘤的临床结果方面有价值，并且可能是评估这些肿瘤侵袭性生物学行为的有用标志物。
