摘要
目的:研究影响骨巨细胞瘤预后的临床和病理因素,探讨可供临床预测患者预后和选择治疗方式的病理形态学指标。方法:从存档病例中选取有完整病历记录和追踪观察的骨巨细胞瘤病例41例,分复发和无复发两组,分析预后与组织学分级、组织形态学测量、免疫组化CD68和Ki67双重表达以及手术方式(病灶内刮除、肿瘤完整切除或广泛切除)的关系。结果:骨巨细胞瘤的预后与组织学分级、单核基质细胞的细胞面积、核面积、核分裂数和Ki67的阳性细胞数以及手术方式有关,而与多核巨细胞的数目和形态、单核基质细胞的核周长、核长/短径比值无关。结论:组织学分级对预测肿瘤的预后仍有一定意义,值得保留供临床参考;组织形态学测量将细胞形态指标量化,能客观地反映肿瘤细胞的异型性,对预测本瘤的预后意义更大,值得进一步探讨;单核基质细胞的异型性和Ki67阳性表达的细胞数与肿瘤复发有关,同时支持单核基质细胞是肿瘤细胞成分的学说;病灶内刮除的术后复发率较高,应尽量避免采用这种手术方式,尤其是对于Jaffe分级为Ⅱ或Ⅲ级的肿瘤、组织细胞形态学测量显示单核基质细胞的细胞面积、核面积及核分裂数高的病例、Ki67免疫组化显示阳性细胞多的病例,应更多选择肿瘤完整切除或广泛切除术。
Objective:To investigate the clinicopathologic factors which can predict the prognosis of giant cell tumor of bone(GCT).Methods:41cases of GCT which had complete medical records and followed up surveys were selected from the files.The relationship between recurrent and non-recurrent groups of their histologic grading,histomorphometry,immunohisto-chemistry of CD 68 and Ki 67 double stain and surgical treatment (intracapsular curettage,local exci-sion or wide excision)were investigated.Results:Prognosis of GCT were correlated with his to-logic grading,nuclear area,mitosis,Ki67positivity of mononuclear stromal cells and the types of surgical operations,not correlated with the number and morphology of multinucleated giant cells,circumference and aspect ratio of the nuclei of mononuclear stromal cells.Conclusion:His tologic grading is still useful for predicting behavior of GCT.Histomorphometry should be further investi-gated because it showed the atypia of tumor cell more objectively and predict the prognosis of GCT more exactly.The number of Ki 67 positive mononuclear stromal cells were correlated with the recurrence.They are probably the tumor cells of GCT.Treatment of intracapsular curettage should be avoided because of its high recurrence;local or wide excision of the tumor should be more frequently chosen especially for the tumors of Jaffe gradeⅡorⅢ,or the tumors with large cell area,nuclear area,more mitosis or more Ki 67 positive cells.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2002年第12期837-840,共4页
Chinese Journal of Clinical Oncology
基金
广东省自然科学基金资助(课题号:A000097140)
