Pollack I F, Campbell J W, Hamilton R L, Martinez A J, Bozik M E
Department of Neurosurgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Cancer. 1997 Feb 15;79(4):849-56.
The prognosis for children with high grade gliomas remains somewhat unpredictable because histologic features alone provide an imperfect assessment of the biologic behavior of a given lesion. Whereas some patients experience prolonged disease control after surgery and adjuvant therapy, others with lesions that appear comparable exhibit rapid disease progression and death.
Because proliferative activity may provide a potential correlate of biologic aggressiveness, the authors examined the relationship between MIB-1 labeling index and outcome in a series of 29 archival pediatric malignant nonbrainstem gliomas from patients treated consecutively at the study institution between 1975 and 1992, in which clinical, histologic, diagnostic, and therapeutic parameters were previously defined. Three patients who died perioperatively were excluded from outcome analyses. All tumors were rereviewed by two neuropathologists and classified as Grade 3 or 4 lesions based on contemporary guidelines.
Among the specimens from the 26 patients who survived the perioperative period, a striking difference in outcome was apparent between tumors with MIB-1 indices < 12 (n = 10) and those with indices > 12 (n = 16). Median progression free survival was >48 months in the low MIB-1 group compared with only 6 months in the high MIB-1 group (P = 0.014, rank-sum test). Median overall survival was >48 months in the low MIB-1 group compared with only 16 months in the high MIB-1 group (P = 0.012). MIB-1 index remained associated with survival after taking into account the effect of resection extent, which also correlated strongly with outcome in this cohort. Although MIB-1 index was associated with histopathologic grade (Grade 3: 11.9 +/- 9.7 vs. Grade 4: 27.3 +/- 19.0; P = 0.015, Fisher's exact test), it proved to be a much stronger predictor of outcome than histology.
MIB-1 index may supplement routine histologic classification as a means for improving the accuracy of predicting the biologic behavior of childhood malignant gliomas and may provide a basis for stratifying patients in future malignant glioma studies and refining therapeutic decision-making.
高级别胶质瘤患儿的预后仍有些难以预测，因为仅靠组织学特征对特定病变的生物学行为评估并不完善。虽然一些患者在手术和辅助治疗后疾病得到长期控制，但其他具有相似病变的患者却表现出疾病快速进展和死亡。
由于增殖活性可能与生物学侵袭性存在潜在关联，作者研究了1975年至1992年间在该研究机构连续接受治疗的29例存档小儿恶性非脑干胶质瘤患者的MIB-1标记指数与预后之间的关系，这些患者的临床、组织学、诊断和治疗参数此前已明确。3例围手术期死亡患者被排除在预后分析之外。所有肿瘤均由两名神经病理学家重新评估，并根据当代指南分类为3级或4级病变。
在围手术期存活的26例患者的标本中，MIB-1指数<12（n = 10）的肿瘤与指数>12（n = 16）的肿瘤在预后方面存在显著差异。低MIB-1组的无进展生存期中位数>48个月，而高MIB-1组仅为6个月（P = 0.014，秩和检验）。低MIB-1组的总生存期中位数>48个月，而高MIB-1组仅为16个月（P = 0.012）。在考虑切除范围的影响后，MIB-1指数仍与生存率相关，切除范围在该队列中也与预后密切相关。虽然MIB-1指数与组织病理学分级相关（3级：11.9 +/- 9.7 vs. 4级：27.3 +/- 19.0；P = 0.015，Fisher精确检验），但事实证明它比组织学更能有力地预测预后。
MIB-1指数可作为常规组织学分类的补充手段，以提高预测儿童恶性胶质瘤生物学行为的准确性，并可为未来恶性胶质瘤研究中的患者分层及优化治疗决策提供依据。
