Long-term survival of glioblastoma multiforme:: importance of histopathological reevaluation
Long-term survival of glioblastoma multiforme:: importance of histopathological reevaluation
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DOI：
10.1007/s004150070175
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发表时间：
2000-06-01
影响因子：
6
通讯作者：
Schlegel, U
中科院分区：
文献类型：
--
作者：
Kraus, JA;Wenghoefer, M;Schlegel, U
多形性胶质母细胞瘤患者的总体预后极差。然而，一小部分患者的生存期延长。本研究回顾性调查了最初诊断为“多形性胶质母细胞瘤”的患者，错误的组织病理学分类对长期生存的影响程度。我们比较了两个年龄和性别匹配的患者组，他们的术后肿瘤进展时间（TTP）不同，TTP小于6个月（n=54）定义为“短期”，TTP大于12个月（n=52）定义为“长期”。根据当前世界卫生组织（WHO）的中枢神经系统肿瘤分类，对相应肿瘤的组织学标本（均初步诊断为多形性胶质母细胞瘤）进行重新评价，研究者对临床结局不知情。在短期TTP患者的肿瘤中，1例肿瘤（2%）被重新分类为间变性少突星形细胞瘤（WHO III级），而其余53例被确认为多形性胶质母细胞瘤。相比之下，来自长期TTP患者的13个肿瘤（25%）被重新分类，大部分分别为间变性少突胶质细胞瘤（WHO III级; n=7）或间变性少突星形细胞瘤（WHO III级，n=2）。此外，3例被重新分类为间变性星形细胞瘤（WHO III级），1例被确定为间变性毛细胞星形细胞瘤（WHO III级）。我们的数据表明，相当大比例的胶质母细胞瘤患者的长期生存，实际上携带恶性胶质瘤少突胶质细胞的功能。这些肿瘤的正确组织病理学识别不仅具有诊断意义，而且具有治疗意义，因为少突胶质细胞肿瘤更可能对化疗产生有利的反应。
The overall prognosis for patients with glioblastoma multiforme is extremely poor. However, a small proportion of patients enjoy prolonged survival. This study investigated retrospectively the extent to which erroneous histopathological classification may contribute to long term survival of patients initially diagnosed with "glioblastoma multiforme." We compared two age- and gender-matched patient groups with different postoperative time to tumor progression (TTP), defined as "shortterm" for TTP of less than 6 months (n=54), and "long-term" for TTP of more than 12 months (n=52). Histological specimens of the corresponding tumors, all primarily diagnosed as glioblastoma multiforme, were reevaluated according to the current World Health Organization (WHO) classification of central nervous system tumors, with the investigators being blinded to clinical outcome. Among the tumors from short-term TTP patients, one tumor (2 %) was reclassified as anaplastic oligoastrocytoma (WHO grade III) while the remaining 53 were confirmed as glioblastoma multiforme. In contrast, 13 tumors (25 %) from the long-term TTP patients were reclassified, mostly as anaplastic oligodendroglioma (WHO grade III; n=7) or anaplastic oligoastrocytoma (WHO grade III, n=2), respectively. In addition, three were reclassified as anaplastic astrocytoma (WHO grade III), and one was identified as anaplastic pilocytic astrocytoma (WHO grade III). Our data indicate that a sizable proportion of glioblastoma patients with long-term survival actually carry malignant gliomas with oligodendroglial features. The correct histopathological recognition of these tumors has not only prognos tic but also therapeutic implications, since oligodendroglial tumors are more likely to respond favorably to chemotherapy.