Burns K L, Ueki K, Jhung S L, Koh J, Louis D N
Department of Pathology (Neuropathology), Massachusetts General Hospital and Harvard Medical School, Boston, USA.
J Neuropathol Exp Neurol. 1998 Feb;57(2):122-30. doi: 10.1097/00005072-199802000-00003.
The vast majority of glioblastomas have CDKN2A, CDK4, or RB gene alterations that perturb the p16-cdk4-pRb cell cycle regulatory cascade. To explore whether immunohistochemical methods provide an alternative means of assessing this pathway, we studied 25 glioblastomas using a combination of molecular genetic and immunohistochemical assays. Homozygous deletion of the CDKN2A gene was detected in 12 of 25 (48%) cases, CDK4 amplification in 4 of 25 (16%) tumors, and loss of heterozygosity at the RB gene in 8 of 22 (36%) informative cases. Five of 25 (20%) glioblastomas had diffuse p16 immunohistochemical positivity. Significantly, all of these had either CDK4 amplification or RB LOH, suggesting that p16 immunopositivity only occurs in those tumors with alterations of another component in the pathway. Nineteen (76%) cases were uniformly immunonegative for p16, and 12 (48%) had CDKN2A homozygous deletions, but the remaining 7 cases lacked CDKN2A deletions, mutations and promoter methylation. All glioblastomas stained diffusely for cdk4, irrespective of CDK4 gene amplification status. Extensive pRb staining was present in most cases that maintained both RB alleles, and absent in most cases with RB loss, but there were notable discrepancies. Thus, p16 and pRb immunohistochemistry cannot replace molecular genetic analysis of this critical regulatory cascade; instead, the combined results hint at complex regulation of this cell cycle checkpoint. From a practical point of view, although p16 immunonegativity does not necessarily indicate CDKN2A deletion, diffuse positive p16 immunostaining strongly suggests either CDK4 amplification or RB loss and excludes CDKN2A deletion.
绝大多数胶质母细胞瘤存在CDKN2A、CDK4或RB基因改变,这些改变扰乱了p16-cdk4-pRb细胞周期调控级联反应。为了探究免疫组化方法是否能提供评估该通路的替代手段,我们结合分子遗传学和免疫组化检测方法对25例胶质母细胞瘤进行了研究。在25例病例中的12例(48%)检测到CDKN2A基因纯合缺失,25例肿瘤中的4例(16%)检测到CDK4扩增,在22例信息充分的病例中的8例(36%)检测到RB基因杂合性缺失。25例胶质母细胞瘤中有5例(20%)p16免疫组化弥漫性阳性。值得注意的是,所有这些病例均存在CDK4扩增或RB基因杂合性缺失,这表明p16免疫阳性仅发生在该通路中其他成分发生改变的肿瘤中。19例(76%)病例p16免疫组化均为阴性,12例(48%)存在CDKN2A纯合缺失,但其余7例没有CDKN2A缺失、突变和启动子甲基化。所有胶质母细胞瘤cdk4均呈弥漫性染色,与CDK4基因扩增状态无关。在大多数保留两个RB等位基因的病例中存在广泛的pRb染色,而在大多数RB缺失的病例中则不存在,但存在明显差异。因此,p16和pRb免疫组化不能替代对这一关键调控级联反应的分子遗传学分析;相反,综合结果提示该细胞周期检查点存在复杂调控。从实际角度来看,虽然p16免疫阴性不一定表明CDKN2A缺失,但p16免疫组化弥漫性阳性强烈提示CDK4扩增或RB缺失,并排除CDKN2A缺失。