Validation of pathological grading systems for predicting metastatic potential in pheochromocytoma and paraganglioma.
Validation of pathological grading systems for predicting metastatic potential in pheochromocytoma and paraganglioma.
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DOI：
10.1371/journal.pone.0187398
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Lee SH
中科院分区：
文献类型：
--
作者：
Koh JM;Ahn SH;Kim H;Kim BJ;Sung TY;Kim YH;Hong SJ;Song DE;Lee SH
提出肾上腺嗜铬细胞瘤和副神经节瘤分级系统（GAPP）用于预测嗜铬细胞瘤和副神经节瘤的转移潜力，以克服肾上腺嗜铬细胞瘤分级评分（PASS）的局限性。然而，迄今为止，还没有进行验证 GAPP 的研究，之前的研究也没有将 B 型琥珀酸脱氢酶 (SDHB) 基因的突变纳入评分计算中。在这项回顾性队列研究中，我们验证了 GAPP 的预测能力，并评估了是否会通过纳入 SDHB 免疫组织化学染色的缺失来提高预测能力。我们根据同步或异时转移的存在将肿瘤分为非转移性和转移性组。测量初次操作时的 GAPP 评分和 PASS。此外，我们将一些 GAPP 参数与 SDHB 的免疫组织化学染色相结合，以获得修改后的 GAPP (M-GAPP) 评分。 15/72 (20.8%) 患者发生转移，平均随访时间为 43.5 个月。转移组中 SDHB 染色丢失更常见 (P = 0.044)。转移组的GAPP评分（P=0.006）、PASS（P=0.003）和M-GAPP评分（P<0.001）均较高。根据 GAPP 评分定义，40 个中分化或低分化肿瘤中有 12 个 (30.0%) 以及 PASS ≥ 4 的 12/34 (35.3%) 肿瘤是转移性的。相反，M-GAPP 评分≥3 的肿瘤有 10/19 (52.6%) 为转移性肿瘤。 M-GAPP 得分的曲线下面积 (0.822) 显着高于 GAPP (0.728) (P = 0.012)，但与 PASS (0.753) 相似 (P = 0.411)。 GAPP (P = 0.032) 和 M-GAPP 评分 (P = 0.040)，但不包括 PASS (P = 0.200)，与无转移生存率呈负相关。 GAPP 得到验证，M-GAPP（一些 GAPP 参数和 SDHB 染色缺失的组合）可能有助于预测嗜铬细胞瘤和副神经节瘤的转移潜力。
The Grading system for Adrenal Pheochromocytoma and Paraganglioma (GAPP) was proposed for predicting the metastatic potential of pheochromocytoma and paraganglioma to overcome the limitations of the Pheochromocytoma of the Adrenal Scaled Score (PASS). However, to date, no study validating the GAPP has been conducted, and previous studies did not include mutations in the succinate dehydrogenase type B (SDHB) gene in the score calculation. In this retrospective cohort study, we validated the prediction ability of GAPP and assessed whether it would be improved by inclusion of the loss of SDHB immunohistochemical staining. We divided the tumors into non-metastatic and metastatic groups based on the presence of synchronous or metachronous metastases. The GAPP score and PASS at the initial operation were measured. Moreover, we combined some GAPP parameters with the immunohistochemical staining of SDHB to obtain a modified GAPP (M-GAPP) score. Metastasis occurred in 15/72 (20.8%) patients, with a mean follow-up of 43.5 months. Loss of SDHB staining was more frequent (P = 0.044) in the metastatic group. The GAPP score (P = 0.006), PASS (P = 0.003), and M-GAPP score (P<0.001) were all higher in the metastatic group. Twelve of 40 (30.0%) moderately or poorly differentiated tumors, as defined by the GAPP score, and 12/34 (35.3%) tumors with a PASS ≥4 were metastatic. Conversely, 10/19 (52.6%) tumors with an M-GAPP score ≥3 were metastatic. The area under the curve of the M-GAPP score (0.822) was significantly higher than that of the GAPP (0.728) (P = 0.012), but similar to that of the PASS (0.753) (P = 0.411). The GAPP (P = 0.032) and M-GAPP scores (P = 0.040), but not PASS (P = 0.200), negatively correlated with metastasis-free survival. The GAPP was validated, and M-GAPP, a combination of some GAPP parameters and loss of SDHB staining, might be useful for the prediction of the metastatic potential of pheochromocytoma and paraganglioma.