Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma
Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma
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DOI：
10.1007/s11060-018-03050-6
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Nasrallah, MacLean P.
中科院分区：
文献类型：
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作者：
Bagley, Stephen J.;Schwab, Robert D.;Nasrallah, MacLean P.
目的：复发性胶质母细胞瘤手术标本的病理组织学特征对预后的影响尚不清楚。我们试图确定放化疗后切除的胶质母细胞瘤肿瘤的关键组织病理学特征是否与总生存期（OS）相关。方法对本院复发性胶质母细胞瘤标本的以下特征进行量化：肿瘤存活程度（占肿瘤和肿瘤细胞组成标本的百分比）、每10个高倍视野的有丝分裂数（0,1 -10,bbb10）、Ki-67增殖指数（0-100%）、透明化（0-6；无到广泛）、稀疏（0-6）、含铁血黄素（0-6）、区域性坏死标本的百分比（0-100%，转换为0-6）。单因素分析中与OS相关的变量，包括年龄、东部肿瘤合作组表现状态（ECOG PS）、重复切除程度、从初次诊断到重复手术的时间以及o -6-甲基鸟嘌呤- dna甲基转移酶启动子甲基化，都被纳入多变量Cox比例风险模型。结果共评估标本37份。在一个多变量模型中，高Ki-67增殖指数是与胶质母细胞瘤重复手术后更差的OS相关的唯一组织病理学特征（风险比（HR） 1.3, 95% CI 1.1-1.5, p=0.003）。从初次诊断到再次手术间隔时间较短（HR 1.11, 95% CI 1.02-1.21, p=0.016）和ECOG PS2 （HR 4.19, 95% CI 1.72-10.21, p=0.002）也与较差的OS独立相关。结论在放化疗后反复切除的胶质母细胞瘤患者中，复发标本Ki-67指数高、复发时间短、PS差与OS差独立相关。活体肿瘤的组织病理学量化与治疗相关的变化对预后的影响有限。
PurposeThe prognostic impact of the histopathologic features of recurrent glioblastoma surgical specimens is unknown. We sought to determine whether key histopathologic characteristics in glioblastoma tumors resected after chemoradiotherapy are associated with overall survival (OS).MethodsThe following characteristics were quantified in recurrent glioblastoma specimens at our institution: extent of viable tumor (accounting for % of specimen comprised of tumor and tumor cellularity), mitoses per 10 high-power fields (0, 1-10, >10), Ki-67 proliferative index (0-100%), hyalinization (0-6; none to extensive), rarefaction (0-6), hemosiderin (0-6), and % of specimen comprised of geographic necrosis (0-100%; converted to 0-6 scale). Variables associated with OS in univariate analysis, as well as age, eastern cooperative oncology group performance status (ECOG PS), extent of repeat resection, time from initial diagnosis to repeat surgery, and O-6-methylguanine-DNA methyltransferase promoter methylation, were included in a multivariable Cox proportional hazards model.Results37 specimens were assessed. In a multivariate model, high Ki-67 proliferative index was the only histopathologic characteristic associated with worse OS following repeat surgery for glioblastoma (hazard ratio (HR) 1.3, 95% CI 1.1-1.5, p=0.003). Shorter time interval from initial diagnosis to repeat surgery (HR 1.11, 95% CI 1.02-1.21, p=0.016) and ECOG PS2 (HR 4.19, 95% CI 1.72-10.21, p=0.002) were also independently associated with inferior OS.ConclusionIn patients with glioblastoma undergoing repeat resection following chemoradiotherapy, high Ki-67 index in the recurrent specimen, short time to recurrence, and poor PS are independently associated with worse OS. Histopathologic quantification of viable tumor versus therapy-related changes has limited prognostic influence.