脑膜瘤中的孕酮和雌激素受体:预后因素。

PubMed ID
发表日期 1997年Jan月

原始出处 神经外科杂志
Journal of neurosurgery
作者 Hsu  D W  Efird  J T  Hedley-Whyte  E T 

文献标题 脑膜瘤中的孕酮和雌激素受体:预后因素。
Progesterone and estrogen receptors in meningiomas: prognostic considerations.

文献摘要

脑膜瘤常含有类固醇激素受体,但受体的存在与患者预后或有丝分裂指数的关系尚不清楚。应用特异性单克隆抗体对70例颅内脑膜瘤患者(男27例,女43例,平均年龄52.9±1.7岁[平均值+/-标准差],年龄范围15~78岁)的女性性激素受体进行免疫细胞化学检测。通过统计分析确定预后相关性,包括临床和组织学变量。良性28例,非典型27例,恶性15例。脑膜上皮瘤30例,成纤维细胞瘤11例,移行性瘤28例,分泌性瘤1例。70例原发肿瘤中29例复发(平均复发间隔50.1±10个月)。无复发患者的平均无进展随访期为82.1+/-7.7个月。孕酮受体(PR)核染色58例(83%),PR状态分为0例(0%细胞核阳性)、1例(<1%)、2例(1-9%)、3例(10-49%)或4例(>50%)。只有6个肿瘤(8.6%)有核雌激素受体(ER)染色,仅限于少数细胞核(<1%)。Fisher精确检验(双尾)显示肿瘤分级与PR染色评分呈负相关(p<or=0.001),96%的良性和40%的恶性脑膜瘤含有PR阳性核。年龄、组织学亚型与PR评分无相关性。女性脑膜瘤患者的PRs较高(p<or=0.05)。方差分析显示,PR染色为0(18+/-4.4)的肿瘤的有丝分裂指数(每10个高倍视野的有丝分裂总数)高于PR评分为1到4(分别为4.3+/-1.9、5.1+/-2、2.2+/-0.8和1.7+/-0.9)的肿瘤(p<or=0.0001)。单因素分析显示PR缺失、高分裂指数和高肿瘤分级是缩短无病间隔的重要因素。多因素分析显示,PR评分为0、有丝分裂指数大于6、恶性肿瘤分级的三因素交互作用模型是脑膜瘤患者预后不良的高度显著预测因子(p<or=0.0001)。这些数据表明PRs的存在,即使是在少数肿瘤细胞中,也是脑膜瘤的一个有利的预后因素。


Meningiomas often contain steroid hormone receptors, but the correlation of receptor presence with patient outcome or mitotic index is unclear. Intracranial meningiomas from 70 patients (27 males and 43 females, mean age 52.9 + 1.7 years [mean +/- standard error of the mean], range 15-78 years) were evaluated immunocytochemically for female sex hormone receptors using specific monoclonal antibodies. Prognostic correlations were determined using statistical analyses that included clinical and histological variables. Twenty-eight tumors were benign, 27 had atypical features, and 15 were malignant. Thirty tumors were meningotheliomatous, 11 were fibroblastic, 28 were transitional, and one was secretory. Twenty-nine of the 70 primary tumors recurred (mean interval to recurrence 50.1 +/- 10 months). The mean progression-free follow-up period for patients without recurrence was 82.1 +/- 7.7 months. Nuclear staining for the progesterone receptor (PR) was found in 58 cases (83%) and PR status was scored as 0 (0% nuclei positive), 1 (< 1%), 2 (1-9%), 3 (10-49%), or 4 (> 50%). Only six tumors (8.6%) contained nuclear estrogen receptor (ER) staining, which was limited to a small number of nuclei (< 1%). Fisher's exact test (two-tailed) showed an inverse correlation between tumor grade and PR staining score (p < or = 0.001), with 96% of benign and 40% of malignant meningiomas containing PR-positive nuclei. No correlation between age or histological subtype and PR score was detected. Meningiomas from female patients had more PRs (p < or = 0.05). Analysis of variance revealed that the mitotic index (total counts of mitoses per 10 high-power fields) for tumors with 0 PR staining (18 +/- 4.4) was higher (p < or = 0.0001) than for those with PR scores of 1 to 4 (4.3 +/- 1.9, 5.1 +/- 2, 2.2 +/- 0.8, and 1.7 +/- 0.9, respectively). Univariate analysis indicated that the absence of PR, high mitotic index, and higher tumor grade were significant factors for shorter disease-free intervals. Multivariate analysis showed that a three-factor interaction model, with a PR score of 0, mitotic index greater than 6, and malignant tumor grade, was a highly significant predictor (p < or = 0.0001) for worse outcome in patients harboring meningiomas. These data indicate that the presence of PRs, even in a small number of tumor cells, is a favorable prognostic factor for meningiomas.


获取全文 10.3171/jns.1997.86.1.0113