Histopathologic grading of medulloblastomas - A pediatric oncology group study

被引:236
作者
Eberhart, CG
Kepner, JL
Goldthwaite, PT
Kun, LE
Duffner, PK
Friedman, HS
Strother, DR
Burger, PC
机构
[1] Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD 21287 USA
[2] Univ Florida, COG Stat Off & Data Ctr, Gainesville, FL USA
[3] St Jude Childrens Res Hosp, Dept Radiat Oncol, Memphis, TN USA
[4] Univ Kentucky, Dept Neurol, Lexington, KY USA
[5] Duke Univ, Dept Pediat, Durham, NC 27706 USA
[6] Texas Childrens Hosp, Houston, TX 77030 USA
关键词
anaplasia; mitosis; apoptosis; prognosis; medulloblastoma; primative neuroectodermal tumors; desmoplasia; nodularity;
D O I
10.1002/cncr.10189
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND. Medulloblastomas are small cell embryonal tumors of the cerebellum found predominantly in children, only slightly more than half of whom survive. Predicting favorable outcome has been difficult, and improved stratification clearly is required to avoid both undertreatment and overtreatment. Patients currently are staged clinically, but no pathologic staging system is in use. Two rare subtypes at extreme ends of the histologic spectrum, i.e., medulloblastomas with extensive nodularity and large cell/anaplastic medulloblastomas, are associated with better and worse clinical outcomes, respectively. However, there is little data about correlations between histologic features and clinical outcome for most patients with medulloblastomas that fall between these histologic extremes of nodularity and anaplasia. Therefore, the authors evaluated the clinical effects of increasing anaplasia and nodularity in a large group of children with medulloblastomas, hypothesizing that increasing nodularity would predict better clinical outcomes and that increasing anaplasia would presage less favorable results. METHODS. Medulloblastomas from 330 Pediatric Oncology Group patients were evaluated histologically with respect to extent of nodularity, presence of desmoplasia, grade of anaplasia, and extent of anaplasia. Pathologic and clinical data were then compared using Kaplan-Meier and log-rank analyses. RESULTS. Increasing grade of anaplasia and extent of anaplasia were associated with progressively worse clinical outcomes (P < 0.0001 for both). Significant anaplasia (moderate or severe) was identified in 24% of medulloblastoma specimens. Neither increasing degree, Of nodularity nor desmoplasia were associated significantly with longer survival. CONCLUSIONS. Moderate anaplasia and severe anaplasia were associated with aggressive clinical behavior in patients with medulloblastomas and were detected in a significant number of specimens (24%). Pathologic grading of medulloblatomas with respect to anaplasia may be of clinical utility. (C) 2002 American Cancer Society
引用
收藏
页码:552 / 560
页数:9
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