In-vivo proliferative potential of primary human brain tumors; its correlation with histological classification and morphological features: I. Gliomas

Loss of heterozygosity of a locus in the chromosomal region 17p13.3 is associated with increased cell proliferation in astrocytic tumors

We had previously reported that loss of heterozygosity (LOH) of the D17S379 locus on 17p13.3 was significantly more frequent in high-grade gliomas (anaplastic astrocytoma, AA; glioblastoma multiforme, GBM) than in those of a low-grade diffuse astrocytoma (DA); however, this was independent of alterations at the TP53 locus, We also showed that LOH of D17S379 was associated with positive staining for p53 protein on immunohistochemistry, but LOH of the TP53 gene had no such association. In this work we show that cell proliferation as determined by MIB-1 labeling index (LI) was significantly higher in tumors with LOH of D17S379 than those with no LOH (NLOH). In accord with our previous results, p53 protein immunopositivity was also associated with increased MIB-1 LI; however, we observed no such association of LI with TP53 LOH. The results further confirm that alteration of one or more putative tumor suppressor loci at 17p13.3 is associated with increased proliferation in astrocytic tumors.

Prognostic relevance of MIB-1 immunoreactivity, S-phase fraction, 5-bromo-2'-deoxyuridine labeling indices, and mitotic figures in gliomas

Prognostic relevance of cell proliferation markers was evaluated in 27 glioma patients. By 1) flow cytometry (FCM), i.e., S-phase fraction (SPF), and BrdUrd-labeling index (LIfcm); 2) immunohistochemistry (IHC), i.e., BrdUrd-labeling index (LIihc) and MIB-1 immunoreactivity (MIB-1 LIihc); and 3) histologic examination, i.e., the presence or absence of cells in mitoses, were assessed. A longer local progression free survival (LPFS) was significantly associated with low SPF, low LIfcm, and low MIB-1 LIihc. For LIihc, no significant association was found. LIfcm appeared to be a more promising prognosticator than MIB-1 LIihc. In comparison with this marker, the presence or absence of mitotic figures appeared to be an even stronger prognosticator. Prognostic significance of LIfcm appeared to be of importance in low-grade gliomas. The number of patients in our study is limited. Our findings were: 1) the presence or absence of cells in mitoses (M-phase activity) appeared to be of more prognostic significance than LIfcm (S-phase activity) and MIB-1 LIihc (non-G0-phase activity); 2) of the tested experimental cell proliferation markers, LIfcm appeared to be of more prognostic significance than MIB-1 LIihc, SPF, and LIihc; and 3) LIfcm is likely to be an important prognosticator in low-grade gliomas and is, therefore, not definitive and only of potential interest.

S-phase fraction, 5-bromo-2'-deoxy-uridine labelling index, duration of S-phase, potential doubling time, and DNA index in benign and malignant brain tumors

Seventy-one histologically malignant brain tumors, 52 histologically benign brain tumors, and 14 cerebral metastases were characterized according to DNA content and proliferative capacity. DNA ploidy, DNA index (DI), S-phase fraction (SPF), 5-bromo-2'-deoxy-uridine (BrdUrd) labelling index (LI), duration of S-phase (Ts), and potential doubling time (Tpot) were assessed by flow cytometry (FCM). In histologically benign tumors, a high percentage of DNA diploid tumors and a low proliferative capacity in DNA diploid tumors were found. Histologically malignant tumors and cerebral metastases were both found to be characterized by a low percentage of DNA diploid tumors and a high proliferative capacity in DNA diploid tumors. The proliferative capacity of DNA aneuploid benign tumors and that of DNA aneuploid malignant tumors, however, appeared not to differ significantly. The number of DNA aneuploid tumors was small. Duration of S-phase was short (range 3.9-4.7 hr) and appeared not to differ between the three groups. From this, the observed differences in Tpot values should be accredited mainly to differences in LI. High-grade as well as low-grade gliomas both appeared to be characterized by malignant (FCM) features, i.e., 1) a high percentage DNA aneuploidy, 2) a high mean DI (for DI > 1), and 3) a high proliferative capacity.

Prognostic value of the proliferation-related antigen Ki-67 in oligodendrogliomas

BACKGROUND

In various neoplasms expression of the proliferation-related Ki-67 antigen has successfully been linked with parameters of progression of disease. While a definite grading scheme for oligodendrogliomas has still not been agreed upon, any parameter of tumor proliferation that might be helpful in predicting clinical outcome should be evaluated.

METHODS

The expression of the proliferation related nuclear antigen Ki-67 (MIB-1 monoclonal antibody) was investigated in a series of 108 verified oligodendrogliomas, and the percentages of immunoreactive cells were compared with the survival times of the patients. Using multivariate analysis the prognostic value of MIB-1 labeling index (LI) was assessed taking into account age, tumor site, grade, and mitotic index (MI).

RESULTS

Patient's age, tumor site, grading according to the grading scheme by Smith, MI and MIB-1 LI were all significantly related to survival. Whereas in a multivariate analysis, age, site, grade and MIB-1 LI had independent prognostic significance, MI failed to add significant prognostic value.

CONCLUSIONS

The MIB-1 LI is an important addition to histopathologic grading for predicting clinical outcome of patients with oligodendrogliomas. The MIB-1 LI adds prognostic information independent of patient's age, tumor site and grade. The MI might be incorporated into a grading scheme for oligodendrogliomas, but is not by itself an additional prognosticator.

c-myc oncogene expression and cell proliferation in mixed oligo-astrocytoma

Mixed gliomas (oligo-astrocytomas) are brain tumours with an admixture of 2 different cell populations: astrocytes and oligodendroglia. On the basis of histological features and behaviour, these tumours are classified as low-grade mixed gliomas (MG) and malignant mixed gliomas (MMG). We have studied the relationship between c-myc protein expression and cellular proliferation in this class of tumours. Using antibody c-33 for c-myc and PC-10 for the proliferating cell nuclear antigen (PCNA), immunohistochemistry was performed on 14 MG and 9 MMG. PCNA was increased in MMG as compared to MG in both astrocytic and oligodendroglial areas. However, more c-myc-positive cells were seen only in the astrocyte areas of MMG. Analysis of the relationship of c-myc and PCNA suggests that the correlation of c-myc with cellular proliferation is dependent on tissue type and differentiation status.

Rearranged p53 gene with loss of normal allele in a low-grade nonrecurrent glioma

We are studying the p53 gene profile in primary glial tumors by seeking alterations in the hybridization pattern of the tumor DNA probed with a p53 gene probe. This report documents a rearranged p53 gene with loss of the normal allele in a low-grade mixed glioma which has not recurred during 4-year follow-up. The tumor had a low 5-bromodeoxyuridine (BrdU)-labeling index and low AgNOR count. The p53 protein was not detected on immunochemical staining. To our knowledge, this is the first report of an altered p53 gene in a low-grade nonrecurrent glial tumor and highlights the presence of further checks and balances on the control of cell proliferation and other malignancy-associated phenotypes, even in an already-established tumor.