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RESUMEN Introducción: Los tumores cerebrales son un grupo heterogéneo dada las diferentes líneas celulares que los originan. Los tumores cerebrales más frecuentes son los que se derivan de la glía, siendo los astrocitomas los más comunes. Objetivo: Sistematizar los hallazgos de los estudios que examinaron múltiples factores pronósticos de supervivencia en pacientes con tumores cerebrales tipo astrocitoma. Método: Se realizó una revisión sistemática de estudios observacionales, analíticos, prospectivos. La búsqueda bibliográfica se efectuó en las bases de datos electrónicas Medline, SciELO, LILACS, PubMed y Google Académico, con los siguientes términos descriptores: edad, sexo, factores pronósticos, cáncer cerebral, astrocitoma. Resultados: En la búsqueda se hallaron 136 452 artículos que estaban distribuidos en diferentes bases de datos. Al aplicar los criterios de elegibilidad quedaron para el análisis 13 artículos. En el caso de los factores pronósticos dependientes de la lesión, tumor o enfermedad, en la mayoría de las investigaciones se mostró una tendencia a evaluar el grado histológico y la histología de la lesión. En el caso de los pronósticos dependientes del paciente existió una mayor inclinación hacia la edad, el sexo y la sintomatología presentada, mientras que en los dependientes del tratamiento se mostraron indistintamente las modalidades de tratamiento sugeridas a los pacientes: cirugía, quimioterapia y radioterapia. Conclusiones: En esta investigación se presentaron los principales factores pronósticos en pacientes con tumores astrocíticos contenidos en las literaturas referentes al tema, que se agrupan en factores pronósticos dependientes del tumor, el paciente y el tratamiento. Estos deben ser tenidos en cuenta para evaluar al paciente con estas lesiones tumorales cerebrales.
ABSTRACT Introduction: Brain tumors are a heterogeneous group given the different cells that originate them. The most frequent brain tumors are those derived from the glia, with astrocytomas being the most common. Objective: To systematize the findings of studies that examined multiple prognostic factors for survival in patients with astrocytoma-type brain tumors. Method: a systematic review of observational, analytical, prospective studies was carried out. The bibliographic search was carried out in the electronic databases Medline, SciELO, LILACS, PubMed and Google Scholar, with the following descriptive terms: age, sex, prognostic factors, brain cancer, astrocytoma. Results: The search found 136,452 articles that were distributed in different databases. When applying the eligibility criteria, 13 articles remained for analysis. In the case of prognostic factors dependent on the lesion, tumor or disease, most researches showed a tendency to evaluate the histologic grade and the histology of the lesion. In the case of the patient-dependent prognoses, there was a greater inclination towards age, sex and the symptoms presented, while in those dependent on the treatment, the treatment modalities suggested to the patients were shown indistinctly: surgery, chemotherapy and radiotherapy. Conclusions: In this research, the main prognostic factors contained in the literature about patients with astrocytic tumors were presented, which are grouped into prognostic factors depending on the tumor, the patient and the treatment. These must be taken into account to evaluate the patient with these brain tumor lesions.
RESUMO Introdução: Os tumores cerebrais são um grupo heterogêneo devido às diferentes linhagens celulares que os originam. Os tumores cerebrais mais frequentes são os derivados da glia, sendo os astrocitomas os mais comuns. Objetivo: Sistematizar os achados de estudos que examinaram múltiplos fatores prognósticos de sobrevida em pacientes com tumores cerebrais do tipo astrocitoma. Método: Foi realizada uma revisão sistemática de estudos observacionais, analíticos e prospectivos. A busca bibliográfica foi realizada nas bases de dados eletrônicas Medline, SciELO, LILACS, PubMed e Google Acadêmico, com os seguintes termos descritivos: idade, sexo, fatores prognósticos, câncer cerebral, astrocitoma. Resultados: A busca encontrou 136.452 artigos que foram distribuídos em diferentes bases de dados. Ao aplicar os critérios de elegibilidade, restaram 13 artigos para análise. No caso de fatores prognósticos dependentes da lesão, tumor ou doença, a maioria das investigações mostrou uma tendência a avaliar o grau histológico e a histologia da lesão. No caso dos prognósticos paciente-dependentes, houve maior inclinação para a idade, sexo e os sintomas apresentados, enquanto nos dependentes do tratamento, as modalidades de tratamento sugeridas aos pacientes foram mostradas indistintamente: cirurgia, quimioterapia e radioterapia. Conclusões: Nesta pesquisa foram apresentados os principais fatores prognósticos em pacientes com tumores astrocíticos contidos na literatura sobre o assunto, os quais são agrupados em fatores prognósticos dependendo do tumor, do paciente e do tratamento. Estes devem ser levados em consideração para avaliar o paciente com essas lesões tumorais cerebrais.
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Background: The World Health Organization (WHO) 2016 classification incorporated molecular subtyping in glioma, highlighting the diagnostic and prognostic significance. The study aims to determine the isocitrate dehydrogenase (IDH-1) gene, α-thalassemia/mental retardation syndrome X-linked (ATRX) gene, and tumor suppressor gene-53 (p53) mutation in glioma and their correlation with various clinical and radiological parameters.Methods: In this prospective observational study, histopathological slides of glioma (2017-2018), were analyzed for IDH-1, ATRX and p53 mutations and their correlation with various clinical and radiological parameters.Results: IDH-1 mutation was found in 48 (38.7%), ATRX loss in 38 (30.6%) and p53 mutation in 40 (32.5%) patients. The expression of IDH-1 was significantly higher (43.7%) in adults; however, no significant difference was seen with gender. Also 51.2% of patients, who presented with seizures, showed IDH-1 expression; and 27.7% of patients, who had neurological deficit also showed IDH-1 expression. IDH-1 expression was high in glioma located at insula (73.3%) and parietal lobe (71.4%); while ATRX loss was seen in glioma located at insula (80%). Intraventricular glioma characteristically lacks all three markers: IDH-1 expression, p53 overexpression and ATRX loss. IDH-1 expression and p53 overexpression was seen mainly in diffuse fibrillary astrocytoma, oligodendroglioma, anaplastic astrocytoma and glioblastoma.Conclusions: Molecular subtyping is of paramount importance in glioma management. IDH-1 mutation is commonly observed in adults and patients presenting with seizures. The duration of symptoms correlates with IDH-1 and ATRX mutations. Hypothalamic tumors lack all three mutations.
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Objective To investigate the value of magnetic resonance (MR)diffusion kurtosis imaging (DKI)in diagnostic classi-fication of astrocytic tumors.Methods 31 patients with astrocytic tumors confirmed by operation and pathology were collected,in-cluding low-grade tumors (WHO gradeⅠ and Ⅱ)in 14 and high-grade ones (WHO grade Ⅲ and Ⅳ)in 1 7.Routine MRI and DKI scan were preoperatively conducted using Siemens 3.0T MR scanner.Mean kurtosis (MK),radial kurtosis (RK)and axial kurtosis (AK)values were calculated in the solid portion of the tumors and the contralateral normal white matter.Results The MK,RK and AK values in tumors were lower than those in contralateral normal white matter,and were significantly higher in high-grade tumors than those in low-grade ones (P <0.05).Conclusion The MK,RK and AK values obtained by DKI reflect the histological structure changes of the astrocytic tumors.DKI is helpful for the diagnostic classification of astrocytic tumors,exhibiting more value in optimi-zing the treatment.
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El cáncer constituye un serio problema de salud para la humanidad. La mayoría de los tumores primarios del Sistema Nervioso Central son tumores astrocíticos. En esta revisión se provee información sobre algunos aspectos relacionados con los tumores astrocíticos, que incluyen la clasificación, factores pronóstico, tratamiento habitual, terapia biológica y factores angiogénicos. El glioblastoma multiforme se diagnostica en los pacientes con una mayor frecuencia. El tratamiento estándar en pacientes con tumores astrocíticos comprende la cirugía, seguida de radiación y quimioterapia. Sin embargo, cada vez son más importantes las investigaciones dirigidas a la inmunoterapia y terapia génica como parte de las opciones terapéuticas en estos pacientes.
Cancer is a serious health problem around the world. The majority of primary tumors of the Central Nervous System are of astrocytic lineage. In this review we provide an overview of several aspects related to this type of tumor, that includes classification, prognostic factors, therapy, and angiogenic factors. Glioblastoma Multiforme is diagnosed in patients at a much higher frequency. Standard treatment for patients with astrocytic tumors is surgery followed by radiotherapy and chemotherapy. However, immunotherapy and gene therapy studies are increasing to become other therapeutic options in these patients.
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OBJECTIVE: This study is designed to investigate the association of tumorigenesis with DNA repair gene, N-methylpurine-DNA-glycosylase(MPG) in astrocytic tumors. METHODS: MPG mRNA expression and localization in the 30 astrocytic tumors and 7 tumor-adjacent brain tissues was examined by reverse transcriptase-polymerase chain reaction(RT-PCR) and RNA in situ hybridization. Expression and intracellular localization of MPG protein was determined by immunohistochemistry. Statistical analysis was performed by ANOVA with a p value<0.05 considered statistically significant. RESULTS: MPG mRNA expression in RT-PCR was significantly higher in grade IV tumor tissues than in brain tissues adjacent to tumor or in grade II-III astrocytic tumor tissues(p<0.05). MPG mRNA in in situ hybridization was detected both in brain tissues adjacent to tumor and in astrocytic tumor tissues, regardless of the tumor grades. However, MPG protein localization in immunohistochemical study was detected only in the nucleus of all tumor tissues. In brain tissues adjacent to tumor, immunohistochemical study for MPG was not stained both in the nucleus and in cytoplasm. CONCLUSION: These results suggest MPG's role in human astrocytic tumors and raise the possibility that the increased mRNA level and intracellular localization could be associated with astrocytic tumorigenesis. Further studies about control of MPG gene expression in astrocytic tumors are warranted.
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Humanos , Encéfalo , Carcinogênese , Citoplasma , Reparo do DNA , DNA , Expressão Gênica , Imuno-Histoquímica , Hibridização In Situ , RNA , RNA MensageiroRESUMO
OBJECTIVE: The cyclin-dependent kinase inhibitor p27kip1 protein is a negative regulator of the cell cycle, and its degradation is required for entry into the S phase. Loss of p27kip1 expression has been reported to be associated with aggressive behavior in a variety of tumors of epithelial and lymphoid origin. However, its association with various astrocytic tumors has not been clearly demonstrated. We studied to investigate the relationship of p27kip1 expression with the biological behavior of astrocytic tumors in addition to study on the role of p27kip1 in the tumorigenesis of these tumors. PATIENTS AND METHODS:From 1990 to 1998, a total of 29 astrocytic tumor of all grades obtained by operative resection were included for evaluation. We studied the expression of p27kip1 protein immunohistochemical assay in astrocytic tumors and compared the findings with the clinicopathologic parameters. Immunohistochemical staining was performed on formalin-fixed paraffin-embedded sections by the avidin-biotin-peroxidase complex method. According to WHO classification, all cases were divided into astrocytomas(4 cases), anaplastic astrocytomas(9 cases), and glioblastomas(16 cases) by 3 pathologists. Clinical information was obtained from medical records, and others such as location and size of tumors from imaging studies. RESULTS: Mean p27kip1 protein labeling indexes(LI, mean+/-standard deviation) of astrocytomas, anaplastic astrocytomas, and glioblastomas were 80.6+/-9.1, 63.6+/-21.0, and 28.9+/-18.7, respectively, and were inversely correlated with grade of glial tumors(p<0.0001). Mean p27kip1 protein LI in the recurrent group was lower than that in the non-recurrent group, but there was no significant difference statistically(p=0.464). Additionally, p27kip1 protein expression did not show any significant relationship to other prognostic factors such as age(p=0.1643), tumor size(p=0.8), or location(p=0.8). CONCLUSION: These results suggested that reduced expression of p27kip1 protein may play a important role in the malignant transformation process of astrocytic tumor cells.