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目的探讨survivin蛋白在原发与继发性胶质母细胞瘤(glioblastoma,GBM)中的表达及其临床病理学意义。方法分别应用免疫组化和TUNEL方法,检测56例GBM(30例原发和26例继发)中survivin的表达和细胞凋亡情况,比较survivin在原发与继发性GBM中的表达差异;分析survivin表达与GBM临床病理学参数之间的相关性。结果56例GBM中,原发GBM中83%(25/30例)呈survivin阳性,继发性GBM中仅46%(12/26例)呈阳性,二者差异有显著性(P<0.01)。在15例配对的继发性GBM与其初发的低级别胶质瘤中,survivin的表达基本一致,7例survivin阳性表达的继发性GBM,其对应的7例低级别胶质瘤中,有6例同时出现survivin阳性;而且多数(4/5例)由间变性胶质瘤(III级)发展而成的继发性GBM出现了survivin的阳性表达,其阳性率明显高于由Ⅱ级胶质瘤演变而成的继发性GBM(3/10例)。另外,大多数(80%)瘤体直径>5cm的GBM呈survivin阳性,并多表现为低的细胞凋亡指数。结论Survivin的阳性表达可能通过其抗凋亡效应,在绝大多数原发性GBM的发生、发展中起了十分重要的作用,但可能只涉及部分继发性GBM的恶性演变;在继发性GBM发生、发展中,survivin阳性表达可能与其初发胶质瘤的病理级别有关。
Objective To investigate the expression of survivin protein in primary and secondary glioblastoma (GBM) and its clinicopathological significance. Methods The expressions of survivin and apoptosis in 56 cases of GBM (30 cases of primary and 26 cases of secondary) were detected by immunohistochemistry and TUNEL respectively. The differences of survivin expression in primary and secondary GBM were compared. The correlation between survivin expression and clinicopathological parameters of GBM was analyzed. Results In 56 cases of GBM, 83% (25/30) cases of primary GBM were positive for survivin, while 46% (12/26 cases) of secondary GBM were positive, the difference was significant (P <0.01) . In 15 paired secondary GBM and its primary low-grade gliomas, the expression of survivin was basically the same, and 7 cases of secondary GBM with survivin expression were positive. Among the 7 cases with low-grade gliomas, there were 6 survivin positive at the same time; and the majority of (4/5 cases) from the development of anaplastic glioma (grade III) secondary GBM survivin positive expression, the positive rate was significantly higher than the level of rubber Tumors evolved from secondary GBM (3/10 cases). In addition, most (80%) GBM tumors> 5 cm in diameter were survivin positive and showed a low apoptotic index. Conclusion The positive expression of Survivin may play an important role in the occurrence and development of most of the primary GBM through its anti-apoptotic effect, but it may only involve the malignant evolution of some secondary GBM. In the secondary The occurrence and development of GBM, the positive expression of survivin may be related to the pathological grade of newly diagnosed glioma.