临床神经外科杂志2025，Vol.22Issue(2)：174-180,7.DOI:10.3969/j.issn.1672-7770.2025.02.009
胶质肉瘤25例临床病理学特征及预后分析
Clinicopathological features and prognosis of gliosarcoma in 25 cases
摘要
Abstract
Objective To investigate the clinicopathological and molecular genetic features of gliosarcoma(GSM)and analyze the prognostic factors.Methods A total of 25 patients diagnosed with GSM from June 2014 to July 2024 in the Molecular Diagnostics Department of Cancer Prevention and Treatment Center of Sun Yat-sen University were collected.The clinicopathological characteristics of the patients were analyzed,and the clinical data of the patients were retrospectively analyzed and followed up.The survival rate of the patients was calculated by Kaplan-Meier method.The effect of single factor analysis on prognostic factors of patients with different Log-rank test analysis.Results There were 25 patients with GSM.Supratentorium was the most common site of tumor,including 9 cases in temporal lobe,3 cases in frontal lobe,3 cases in parietal lobe,2 cases in frontotemporal lobe,base temporal lobe and parietal occipital lobe,and 1 case in occipital lobe,thalamus,cerebellum and bilateral lateral ventricles.The tumor diameter was 1.2-8.0 cm,and the median tumor size was 4.5 cm.There were 17 cases of primary gliosarcomas(PGS)and 8 cases of secondary gliosarcomas(SGS).Immunohistochemical tests showed that glioma cells expressed GFAP positively,and sarcoma cells expressed GFAP negatively and were surrounded by reticular fibers alone.IDH1 was negative in all 25 cases,13 patients were positive for Olig-2(13/18),and all had positive expression of ATRX protein(15/15).There were 10 cases of p53 mutation(10/19),MGMT methylation in 3 cases(3/14),with Ki-67 positive index ranging from 5％to 95％.Molecular genetic detection showed that 6 cases(6/12)of TERT gene promoter mutation,BRAF gene V600E mutation site were wild type(0/7),2 cases(2/18)of 1p deletion and 19q deletion,1 case(1/18)of 1p deletion and 19q deletion.EGFR gene amplification in 1 case(1/12),PTEN gene deletion in 1 case(1/6).There were 24 cases of surgical resection,1 case of biopsy,17 cases(17/25)of postoperative radiotherapy plus temozolomide(TMZ)chemotherapy,4 cases(4/25)of postoperative radiotherapy or chemotherapy,and 4 cases(4/25)of simple surgery.Extracranial metastasis occurred in 5 cases(5/25),4 cases lost follow-up,16 cases died.The mean overall survival(OS)of the 19 patients was 16.57 months,and the progression-free survival(PFS)was 8.47 months.Single factor analysis showed that the clinicopathological and molecular characteristics of the patients,such as gender,age and tumor size,had no significant correlation with the prognosis(P＞0.05).The Log-rank analysis results showed that PGS patients had significantly better PFS and OS than SGS patients(P＜0.05),and the difference was statistically significant.Conclusions GSM has the characteristics of biphasic histology and pathology,the incidence of the disease is low,the extent of malignancy is high,and the prognosis is poor.The prognosis of PGS patients was significantly better than that of SGS patients.关键词
胶质肉瘤/临床病理/分子病理/治疗/预后Key words
gliosarcoma/clinicopathology/molecular pathology/treatment/prognosis分类
医药卫生引用本文复制引用
钟晓妮,邓绮玲,樊漪波,王芳,吴小延..胶质肉瘤25例临床病理学特征及预后分析[J].临床神经外科杂志,2025,22(2):174-180,7.基金项目
国家自然科学基金项目(81602468) （81602468）
广东省基础与应用基础研究基金项目(2020A1515010313,2017A030310192) （2020A1515010313,2017A030310192）
中山大学青年教师培育项目(17ykpy84) （17ykpy84）
