胶质母细胞瘤的病理组织学及分子遗传学与患者预后的关系

Correlation among Pathologic Histology, Molecular Genetics and Patient Outcomes in Glioblastomas

本文讨论了胶质母细胞瘤的病理组织学、分子遗传学和患者预后间的关系。病理组织学特征包括主要的细胞类型(小细胞,非小细胞)其他一些改变,如少突胶质细胞成分、星形细胞瘤区、肥胖细胞、多核巨细胞以及坏死和微血管增殖。大约20%的胶质母细胞瘤中可以见到少突胶质细胞成分,这些患者生存期稍长;LOH1p的胶质母细胞瘤病例生存期较长,而LOH19q的病例生存期较短。胶质母细胞瘤中大约有5%或更多的多核巨细胞,较之多核巨细胞少见的胶质母细胞瘤,常见有P53突变和少见的EGFR扩增。所有的胶质母细胞瘤中均可见微血管增殖。伴有大片血管性坏死区的患者生存期较短。这些特征提示胶质母细胞瘤的一些组织学改变和特殊的遗传学改变与临床预后相关。

In this article, the correlation among pathologic histology, molecular genetics and patient outcomes in glioblastomas was discussed. Pathologic histologic characteristics include major cell types （small cell, Non small cell）, and other components, such as oligodendroglial components, areas of astrocytoma, gemistocytes, muhinucleated giant cells as well as necrosis and microvascular proliferation. An oligodendroglial component was detected in 20% of glioblastomas and patients with oligodendroglial components had better prognosis. LOH lp was associated with longer survival whereas LOH19q was associated with shorter survival of patients with glioblasfoma. Glioblastomas containing more than 5% multinucleated giant cells showed more frequent P53 mutation and infrequent EGFR amplification than those containing less than 5% multinucleated giant cells. Vascular proliferation was observed in all glioblastomas. The patients with large areas of angionecrosis were associated with shorter survival. These characteristics in glioblastomas are associated with specific genetic alterations and with clinical outcome.