Galanis E, Buckner J C, Dinapoli R P, Scheithauer B W, Jenkins R B, Wang C H, O'Fallon J R, Farr G
Department of Oncology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Neurosurg. 1998 Sep;89(3):425-30. doi: 10.3171/jns.1998.89.3.0425.
Gliosarcoma, a rare malignancy of the central nervous system, consists of gliomatous and sarcomatous elements. There are conflicting reports regarding its aggressiveness and cell line of origin compared with those of glioblastoma multiforme (GBM). The goal of this study was to compare clinicopathological features such as disease-free survival time and actual survival time in patients with gliosarcoma with a matched group of patients with GBM as well as with the entire group of patients with GBM.
The authors report on 18 cases of gliosarcoma derived from a series of 748 Grade 4 astrocytoma cases that were part of four consecutive randomized Phase III trials conducted between 1979 and 1996. In this series the gliosarcoma group represented only 2.4% of all GBMs and included 11 men and seven women with a median age of 61.5 years (range 31-81 years). The median tumor size was 5 cm (range 2-8 cm). The locations, all supratentorial, included temporal in 44%, parietal in 28%, frontal in 17%, and occipital in 11%. The 18 patients with gliosarcomas, all Grade 4 (World Health Organization classification), were compared with the entire group of 730 patients with GBM and a control group of 18 patients with GBM matched for known prognostic factors including patient age, randomization date, performance status, extent of resection, and protocol number. Patients in all treatment groups received radiation and nitrosourea-based chemotherapy. The median time to progression and the median survival times for the patients with gliosarcoma were 28.0 and 35.1 weeks as compared with 24.7 and 41.6 weeks for the entire group of patients with GBM (log rank test, p = 0.94 and 0.27, respectively) and 16.7 and 34.4 weeks in the control group (p = 0.20 and 0.84, respectively). In previous molecular cytogenetic analyses of gliosarcoma these authors have shown similar genetic changes in the gliomatous and sarcomatous components.
The data obtained in this study support the conclusion that gliosarcoma shares significant clinical and genetic similarities with GBM and that the same principles should be applied for patient enrollment in research protocols and treatment for these two kinds of tumor.
胶质肉瘤是中枢神经系统的一种罕见恶性肿瘤，由胶质瘤成分和肉瘤成分组成。与多形性胶质母细胞瘤（GBM）相比，关于其侵袭性和起源细胞系的报道存在矛盾。本研究的目的是比较胶质肉瘤患者与匹配的GBM患者组以及整个GBM患者组的无病生存时间和实际生存时间等临床病理特征。
作者报告了18例胶质肉瘤病例，这些病例来自1979年至1996年期间进行的四项连续随机III期试验中的748例4级星形细胞瘤病例系列。在该系列中，胶质肉瘤组仅占所有GBM的2.4%，包括11名男性和7名女性，中位年龄为61.5岁（范围31 - 81岁）。肿瘤中位大小为5 cm（范围2 - 8 cm）。所有肿瘤均位于幕上，其中颞叶占44%，顶叶占28%，额叶占17%，枕叶占11%。18例胶质肉瘤患者均为4级（世界卫生组织分类），与730例GBM患者的整个组以及18例与已知预后因素匹配的GBM患者对照组进行比较，这些预后因素包括患者年龄、随机分组日期、功能状态、切除范围和方案编号。所有治疗组的患者均接受放疗和基于亚硝基脲的化疗。胶质肉瘤患者的中位进展时间和中位生存时间分别为28.0周和35.1周，而GBM患者整个组分别为24.7周和41.6周（对数秩检验，p分别为0.94和0.27），对照组分别为16.7周和34.4周（p分别为0.20和0.84）。在先前对胶质肉瘤的分子细胞遗传学分析中，这些作者已表明在胶质瘤成分和肉瘤成分中存在相似的基因变化。
本研究获得的数据支持以下结论，即胶质肉瘤与GBM在临床和基因方面存在显著相似性，并且在研究方案的患者入组和这两种肿瘤的治疗中应应用相同的原则。
