目的探讨I D H突变和1p/19q共缺失型少突胶质细胞瘤的临床病理特征及预后相关影响因素。方法收集54例IDH突变和1p/19q共缺失型少突胶质细胞瘤病例,分析其临床病理特点,包括年龄、组织学分级和肿瘤部位等因素对无进展生存期和总生存期的...目的探讨I D H突变和1p/19q共缺失型少突胶质细胞瘤的临床病理特征及预后相关影响因素。方法收集54例IDH突变和1p/19q共缺失型少突胶质细胞瘤病例,分析其临床病理特点,包括年龄、组织学分级和肿瘤部位等因素对无进展生存期和总生存期的影响。结果 54例患者中,肿瘤发生于1个脑叶者46例,发生于2个脑叶以上者8例。肿瘤组织学WHO分级2级12例,3级42例。FISH检测显示54例均为1p/19q共缺失;免疫组织化学检测显示Olig2均为弥漫强阳性;GFAP均为阳性;p53有6例强阳性;48例患者ATRX未缺失;Ki-67增殖指数5%~60%。Sanger测序显示54例均发生IDH基因突变(40例为IDH1突变,14例为IDH2突变),33例发生TERT启动子突变。16例在治疗过程中发生复发及转移。单因素分析显示,手术后复发转移间隔时间超过2年可以延长患者无进展生存和总生存期。54例患者平均无进展生存期33.5个月,平均总生存期40.7个月。结论 IDH突变和1p/19q共缺失型少突胶质细胞瘤术后联合精准放化疗降低了进展风险,手术后复发转移间隔时间与该型患者预后相关。展开更多
Background: Oligodendroglial neoplasms with combined loss of chromosomes 1p a nd 19q may have a good prognosis and respond to procarbazine- lomustine (CCNU) - vincristine (PCV)- chemotherapy. Objective: To determine w...Background: Oligodendroglial neoplasms with combined loss of chromosomes 1p a nd 19q may have a good prognosis and respond to procarbazine- lomustine (CCNU) - vincristine (PCV)- chemotherapy. Objective: To determine whether single voxe l magnetic resonance spectroscopy (SV- MRS) obtained through routine clinical p ractice distinguishes between histopathologic and genetic subtypes of oligodendr oglial tumors. Methods: Forty- eight patients with oligodendroglial tumors (19 oligodendrogliomas and 29 oligoastrocytomas) underwent molecular genetic analysis to determine allelic imbalance in chromoso mes 1p36 and 19q13. SV- MRS was obtained pretherapy to determine tumor metaboli te ratios. Results: Grade III oligodendroglial tumors had higher choline (Mann- Whitney; p=0.002), methyl lipid (Mann- Whitney; p=0.002), and combined methyle ne lipid and lactate ratios (Mann- Whitney; p < 0.001)- than grade II tumors. Lactate did not distinguish between tumor types (Fisher exact test; p=0.342) or grade (Fisher exact test; p=0.452). There were no significant associations when tumors were analyzed according to histopathology or genetic subtypes. Conclusion : As a noninvasive diagnostic tool used in routine clinical practice, SV- MRS h as the potential benefit of determining oligodendroglial tumor grade but not sub types classified by histopathology or molecular genetics. MRS may be useful for determining the timing of therapy but is unlikely to predict chemosensitivity.展开更多
文摘目的探讨I D H突变和1p/19q共缺失型少突胶质细胞瘤的临床病理特征及预后相关影响因素。方法收集54例IDH突变和1p/19q共缺失型少突胶质细胞瘤病例,分析其临床病理特点,包括年龄、组织学分级和肿瘤部位等因素对无进展生存期和总生存期的影响。结果 54例患者中,肿瘤发生于1个脑叶者46例,发生于2个脑叶以上者8例。肿瘤组织学WHO分级2级12例,3级42例。FISH检测显示54例均为1p/19q共缺失;免疫组织化学检测显示Olig2均为弥漫强阳性;GFAP均为阳性;p53有6例强阳性;48例患者ATRX未缺失;Ki-67增殖指数5%~60%。Sanger测序显示54例均发生IDH基因突变(40例为IDH1突变,14例为IDH2突变),33例发生TERT启动子突变。16例在治疗过程中发生复发及转移。单因素分析显示,手术后复发转移间隔时间超过2年可以延长患者无进展生存和总生存期。54例患者平均无进展生存期33.5个月,平均总生存期40.7个月。结论 IDH突变和1p/19q共缺失型少突胶质细胞瘤术后联合精准放化疗降低了进展风险,手术后复发转移间隔时间与该型患者预后相关。
文摘Background: Oligodendroglial neoplasms with combined loss of chromosomes 1p a nd 19q may have a good prognosis and respond to procarbazine- lomustine (CCNU) - vincristine (PCV)- chemotherapy. Objective: To determine whether single voxe l magnetic resonance spectroscopy (SV- MRS) obtained through routine clinical p ractice distinguishes between histopathologic and genetic subtypes of oligodendr oglial tumors. Methods: Forty- eight patients with oligodendroglial tumors (19 oligodendrogliomas and 29 oligoastrocytomas) underwent molecular genetic analysis to determine allelic imbalance in chromoso mes 1p36 and 19q13. SV- MRS was obtained pretherapy to determine tumor metaboli te ratios. Results: Grade III oligodendroglial tumors had higher choline (Mann- Whitney; p=0.002), methyl lipid (Mann- Whitney; p=0.002), and combined methyle ne lipid and lactate ratios (Mann- Whitney; p < 0.001)- than grade II tumors. Lactate did not distinguish between tumor types (Fisher exact test; p=0.342) or grade (Fisher exact test; p=0.452). There were no significant associations when tumors were analyzed according to histopathology or genetic subtypes. Conclusion : As a noninvasive diagnostic tool used in routine clinical practice, SV- MRS h as the potential benefit of determining oligodendroglial tumor grade but not sub types classified by histopathology or molecular genetics. MRS may be useful for determining the timing of therapy but is unlikely to predict chemosensitivity.
