Pathological, Immunohistochemical and Molecular Analysis of Recurrent Glioblastoma
재발성 교모세포종의 병리학적, 면역화학조직학적, 분자적 분석
Glioblastoma is the most frequent and most malignant neoplasm of the brain. Most of glioblastomas recur or progress despite primary treatments. However, clinical significance of pathologic diagnosis of recurrent glioblastoma is controversial. To evaluate the prognostic value of the volume of residual viable tumor versus therapy-induced necrosis in the resection material and the diagnostic value of ancillary tests in recurrent glioblastoma, we conducted a retrospective review of 20 patients whose initial and recurrent specimens were available. Recurrent glioblastomas were graded according to the extent of histopathologic parameters: recurrent tumor with high and non-high-grade, pure high-grade tumor components, and therapy-related necrosis. We also examined MIB-1 labeling, isocitrate dehydrogenase 1R132H mutation, and epidermal growth factor receptor amplification in primary and recurrent glioblastomas. To evaluate patient outcomes according to clinical and pathologic parameters, a survival analysis was performed and correlations between histopathologic parameters and each ancillary test were assessed. Among clinical parameters, age greater than 60 years was associated with decreased survival (p = 0.022) but other clinical parameters showed no significant association with overall survival. Among the three histopathologic parameters, the extent of recurrent tumor, including high and non-high-grade components, revealed a significant association with overall survival (p = 0.042), but neither the extent of pure high-grade components nor therapy-related necrosis showed any prognostic value. MIB-1 labeling, isocitrate dehydrogenase 1R132H mutation, and epidermal growth factor receptor amplification were useful for the diagnosis of recurrent glioblastomas but showed no prognostic value. Our data suggest that histopathologic evaluation on the base of tumor extent in resected recurrent glioblastoma specimens may provide additional prognostic information concerning the survival of patients with recurrent glioblastoma
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