Abramovich C M, Prayson R A
Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA.
Hum Pathol. 1998 Dec;29(12):1420-7. doi: 10.1016/s0046-8177(98)90010-7.
Predicting tumor behavior in meningiomas based on histology alone has been problematic. This study retrospectively compares histology and MIB-1 (cell proliferation marker) labeling indices (LI) in benign, aggressive, and malignant meningiomas. Six histological features, including mitoses, necrosis, loss of pattern, hypervascularity/hemosiderin deposition, prominent nucleoli, and nuclear pleomorphism, were compared in 90 meningiomas (Fisher's exact test). Tumors with two or more of the above features were designated as aggressive meningiomas. Malignant meningiomas were characterized by brain invasion or metastasis. The MIB-1 LIs (% positive tumor cell nuclei) were compared between the three groups (Kruskal-Wallis test, Wilcoxon two-sample test). Of the benign meningiomas (n=37; mean age, 54 years), 41% had one of the six histological features, with nuclear pleomorphism (n=10) being the most frequent. The aggressive tumors (n=29; mean age, 61 years) were characterized by nuclear pleomorphism (n=28), mitoses (n=20), necrosis (n=16), loss of pattern (n=16), prominent nucleoli (n=6), and hypervascularity/hemosiderin deposition (n=5). Malignant tumors (n=24; mean age, 59 years) were characterized by nuclear pleomorphism (n=22), mitoses (n=21), loss of pattern (n=21), necrosis (n=21), nucleoli (n=17), and hypervascularity/hemosiderin deposition (n=3). Significant differences were found between the aggressive and malignant groups with regard to loss of pattern, necrosis, and nucleoli (P=.0043, .011, and .00029, respectively). Mean MIB-1 LIs for the benign, aggressive, and malignant groups were 1.0% (range, 0 to 5.5%),5.5% (range, 0.1 to 32.5%), and 12.0% (range, 0.3 to 32.5%), respectively. Differences in the mean MIB-1 LI between groups were statistically significant, with P values of <.0001 (benign v aggressive) and .0012 (aggressive v malignant). Mean MIB-1 LIs for recurrent versus nonrecurrent tumors were 7.1% (range, 0 to 32.5%) versus 3.8% (range, 0 to 20.9%) (P=.32). The mean MIB-1 LI for patients who were alive with or without tumor was 6.2% (range, 0 to 32.5%) versus a mean MIB-1 LI of 14.2% (range, 2.8% to 32.5%) for patients who died of or with tumor (P=.0013). In conclusion, (1) There is a statistically significant difference in the increasing MIB-1 LI means between benign, aggressive, and malignant meningiomas and between patients who were alive versus those who died; (2) there is some overlap in MIB-1 LI ranges between groups, which warrants caution in interpreting an individual MIB-1 LI in a given tumor.
仅基于组织学来预测脑膜瘤的肿瘤行为一直存在问题。本研究回顾性比较了良性、侵袭性和恶性脑膜瘤的组织学及MIB-1（细胞增殖标志物）标记指数（LI）。在90例脑膜瘤中比较了六项组织学特征，包括有丝分裂、坏死、结构消失、血管增多/含铁血黄素沉积、核仁显著及核多形性（Fisher精确检验）。具有两项或更多上述特征的肿瘤被指定为侵袭性脑膜瘤。恶性脑膜瘤的特征为脑侵袭或转移。比较了三组之间的MIB-1 LI（%阳性肿瘤细胞核）（Kruskal-Wallis检验，Wilcoxon双样本检验）。在良性脑膜瘤（n = 37；平均年龄54岁）中，41%具有六项组织学特征之一，其中核多形性（n = 10）最为常见。侵袭性肿瘤（n = 29；平均年龄61岁）的特征为核多形性（n = 28）、有丝分裂（n = 20）、坏死（n = 16）、结构消失（n = 16）、核仁显著（n = 6）及血管增多/含铁血黄素沉积（n = 5）。恶性肿瘤（n = 24；平均年龄59岁）的特征为核多形性（n = 22）、有丝分裂（n = 21）、结构消失（n = 21）、坏死（n = 21）、核仁（n = 17）及血管增多/含铁血黄素沉积（n = 3）。侵袭性和恶性组在结构消失、坏死和核仁方面存在显著差异（P分别为0.0043、0.011和0.00029）。良性、侵袭性和恶性组的平均MIB-1 LI分别为1.0%（范围0至5.5%）、5.5%（范围0.1至32.5%）和12.0%（范围0.3至32.5%）。组间平均MIB-1 LI差异具有统计学意义，良性与侵袭性比较的P值<0.0001，侵袭性与恶性比较的P值为0.0012。复发肿瘤与未复发肿瘤的平均MIB-1 LI分别为7.1%（范围0至32.5%）和3.8%（范围0至20.9%）（P = 0.32）。有肿瘤存活或无肿瘤存活患者的平均MIB-1 LI为6.2%（范围0至32.5%），而死于肿瘤或伴有肿瘤患者的平均MIB-1 LI为14.2%（范围2.8%至32.5%）（P = 0.0013）。总之，（1）良性、侵袭性和恶性脑膜瘤之间以及存活患者与死亡患者之间，MIB-1 LI平均值的增加存在统计学显著差异；（2）组间MIB-1 LI范围存在一些重叠，这在解释给定肿瘤中的个体MIB-1 LI时需要谨慎。
