A nuclear grading system is a strong predictor of survival in epitheloid diffuse malignant pleural mesothelioma.
A nuclear grading system is a strong predictor of survival in epitheloid diffuse malignant pleural mesothelioma.
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DOI：
10.1038/modpathol.2011.146
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发表时间：
2012-02
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上皮样间皮瘤是弥漫性恶性胸膜间皮瘤中最常见的亚型，其中只有分期是预后生存。在这项上皮样弥漫性恶性胸膜间皮瘤的研究中，我们探讨了细胞核特征的预后效用。对来自同一机构的232例上皮样弥漫性恶性胸膜间皮瘤患者（14例I期，54例II期，130例III期和34例IV期）的载玻片进行了以下7项核特征的审查：核小体，核/胞质比，染色质模式，核内包涵体，核仁突出，有丝分裂计数和非典型有丝分裂。采用组织芯片进行MIB-1免疫组化，MIB-1标记指数记录为阳性肿瘤细胞的百分比。所有患者的中位总生存期为16个月，单因素分析显示，与核小体（P<0.001）、染色质类型（P= 0.031）、核仁突出（P <0.001）、有丝分裂计数（P<0.001）和非典型有丝分裂（P<0.001）相关。多因素分析显示核分裂计数（P=0.012）和核分裂计数（P<0.001）是独立的预后因素，这两个因素被用来创建一个三级核分级评分。结果核分级将患者分为三个不同的预后组：I级（n=107，中位总生存期= 28个月），II级（n=91，14个月）和III级（n=34，5个月）。核分级不仅是总生存率的独立预测因子（P<0.001），而且是比目前所有可用因素更强的生存率预测因子。此外，在接受完全手术切除的患者（n=159）中，核分级与复发时间相关（P=0.004）。MIB-1标记指数与有丝分裂计数（P<0.001）、细胞核异常（P=0.037）、分层总生存期（P<0.001）和复发时间（P=0.048）相关，证实了细胞核分级的预后价值。上皮样间皮瘤的细胞核分级提供了一个简单、实用、经济的预后工具，比目前可用的临床病理因素更好地对临床结果和复发时间进行分层。
Epithelioid mesothelioma is the most prevalent subtype of diffuse malignant pleural mesothelioma in which only staging is prognostic for survival. In this study of epithelioid diffuse malignant pleural mesothelioma, we investigate the prognostic utility of nuclear features. The slides of 232 epithelioid diffuse malignant pleural mesothelioma patients (14 stage I, 54 stage II, 130 stage III, and 34 stage IV) from a single institution were reviewed for the following seven nuclear features: nuclear atypia, nuclear/cytoplasmic ratio, chromatin pattern, intranuclear inclusions, prominence of nucleoli, mitotic count, and atypical mitoses. MIB-1 immunohistochemistry was performed using tissue microarray, and MIB-1 labeling index was recorded as the percentage of positive tumor cells. Median overall survival of all patients was 16 months and correlated with nuclear atypia (P<0.001), chromatin pattern (P=0.031), prominence of nucleoli (P<0.001), mitotic count (P<0.001), and atypical mitoses (P<0.001) by univariate analysis. Multivariate analysis revealed nuclear atypia (P=0.012) and mitotic count (P<0.001) as independent prognostic factors, and these two factors were utilized to create a three-tier nuclear grade score. The resulting nuclear grade stratified patients into three distinct prognostic groups: grade I (n=107, median overall survival = 28 months), grade II (n=91, 14 months), and grade III (n=34, 5 months). Not only was nuclear grade an independent predictor of overall survival (P<0.001), but it was also a stronger discriminator of survival than all currently available factors. Furthermore, nuclear grade was associated with time to recurrence (P=0.004) in patients who underwent complete surgical resection (n=159). MIB-1 labeling index correlated with mitotic count (P<0.001) and nuclear atypia (P=0.037) and stratified overall survival (P<0.001) and time to recurrence (P=0.048), confirming the prognostic value of the nuclear grade. Nuclear grading in epithelioid mesothelioma provides a simple, practical, and cost-effective prognostic tool that better stratifies clinical outcome and time to recurrence than currently available clinicopathologic factors.
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