Progesterone and estrogen receptors in meningiomas: Prognostic considerations
Progesterone and estrogen receptors in meningiomas: Prognostic considerations
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DOI：
10.3171/jns.1997.86.1.0113
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发表时间：
1997-01-01
影响因子：
4.1
通讯作者：
HedleyWhyte, ET
中科院分区：
文献类型：
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作者：
Hsu, DW;Efird, JT;HedleyWhyte, ET
脑膜瘤通常含有类固醇激素受体，但受体的存在与患者预后或有丝分裂指数的相关性尚不清楚。对70例颅内脑膜瘤患者(男27例，女43例，年龄15~78岁，平均年龄52.9±1.7岁[平均+/-标准差])进行了女性性激素受体免疫细胞化学检测。使用包括临床和组织学变量的统计分析来确定预后相关性。良性28例，不典型27例，恶性15例。脑膜瘤30例，成纤维细胞瘤11例，移行细胞瘤28例，分泌性肿瘤1例。70例原发肿瘤中29例复发(平均复发间隔50.1±10个月)。无复发患者的平均无进展随访期为82.1+/-7.7个月。孕激素受体(PR)核阳性58例(83%)，PR状态分为0(核阳性)、1(1%)、2(1-9%)、3(10-49%)或4(50%)。只有6个肿瘤(8.6%)有雌激素受体(ER)染色，仅限于少数细胞核(1%)。Fisher‘s Exact检验(双尾检验)显示肿瘤分级与PR染色评分呈负相关(p<0.001)，96%的良性脑膜瘤和40%的恶性脑膜瘤含有PR阳性核。未发现年龄或组织学亚型与PR评分相关。女性脑膜瘤的PR较高(P<0.05)。方差分析显示，PR染色为0.0001+/-4.4的肿瘤的核分裂指数(每10个高倍视野有丝分裂细胞总数)高于PR评分为1~4的肿瘤(分别为4.3+/-1.9、5.1+/-2、2.2+/-0.8和1.7+/-0.9)。单因素分析显示，PR缺失、核分裂指数高、肿瘤分级高是导致无病间隔时间缩短的重要因素。多变量分析显示，PR评分为0.0001，有丝分裂指数大于6，恶性肿瘤分级的三因素交互作用模型是脑膜瘤患者预后较差的极显著预测因子(p<；0.0001)。这些数据表明，PR的存在，即使在一小部分肿瘤细胞中，也是脑膜瘤有利的预后因素。
Meningiomas often contain steroid hormone receptors, but the correlation of receptor presence with patient outcome or mitotic index is unclear. Intracranial meningiomas from 70 patients (27 males and 43 females, mean age 52.9 + 1.7 years [mean +/- standard error of the mean], range 15-78 years) were evaluated immunocytochemically for female sex hormone receptors using specific monoclonal antibodies. Prognostic correlations were determined using statistical analyses that included clinical and histological variables. Twenty-eight tumors were benign, 27 had atypical features, and 15 were malignant. Thirty tumors were meningotheliomatous, 11 were fibroblastic, 28 were transitional, and one was secretory. Twenty-nine of the 70 primary tumors recurred (mean interval to recurrence 50.1 +/- 10 months). The mean progression-free follow-up period for patients without recurrence was 82.1 +/- 7.7 months. Nuclear staining for the progesterone receptor (PR) was found in 58 cases (83%) and PR status was scored as 0 (0% nuclei positive), 1 (< 1%), 2 (1-9%), 3 (10-49%), or 4 (> 50%). Only six tumors (8.6%) contained nuclear estrogen receptor (ER) staining, which was limited to a small number of nuclei (< 1%). Fisher's exact test (two-tailed) showed an inverse correlation between tumor grade and PR staining score (p less than or equal to 0.001), with 96% of benign and 40% of malignant meningiomas containing PR-positive nuclei. No correlation between age or histological subtype and PR score was detected. Meningiomas from female patients had more PRs (p less than or equal to 0.05). Analysis of variance revealed that the mitotic index (total counts of mitoses per 10 high-power fields) for tumors with 0 PR staining (18 +/- 4.4) was higher (p less than or equal to 0.0001) than for those with PR scores of 1 to 4 (4.3 +/- 1.9, 5.1 +/- 2, 2.2 +/- 0.8, and 1.7 +/- 0.9, respectively). Univariate analysis indicated that the absence of PR, high mitotic index, and higher tumor grade were significant factors for shorter disease-free intervals. Multivariate analysis showed that a three-factor interaction model, with a PR score of 0, mitotic index greater than 6, and malignant tumor grade, was a highly significant predictor (p < 0.0001) for worse outcome in patients harboring meningiomas. These data indicate that the presence of PRs, even in a small number of tumor cells, is a favorable prognostic factor for meningiomas.