Glioma is one of the most common primary tumors in the human brain with poor prognosis. The local and systemic immunosuppressive environment created by glioma cells enables them to evade immunosurveillance. Myeloid-derived suppressor cells (MDSCs) are a critical component of the immunosuppression system. They are a heterogeneous cell population composed of early myeloid progenitor cells and precursor cells. Although the cells are diverse in phenotypes and functions, they all have strong immunosuppressive functions. MDSCs are extensively infiltrated into tumor tissues and play an important role in the glioma immunosuppressive microenvironment, which also hinders the immunotherapeutic effects of glioma. This article will review the phenotypic characteristics of MDSCs in the glioma microenvironment and their role in the progression of glioma. It is of positive significance to better understand the pathogenesis of glioma and explore effective comprehensive treatments.
【摘要】 目的 探讨高级别胶质瘤患者放射、化学治疗后假性进展的临床特点、诊断与处理。 方法 分析2008年6月-2009年6月接受综合治疗的31例高级别胶质瘤患者临床资料，对假性进展的患者进行回顾分析，按照实体瘤疗效评判标准应用磁共振进行疗效评价。 结果 31例术后病理诊断为高级别胶质瘤的患者，替莫唑胺（TMZ）同期放射、化学治疗后维持TMZ辅助化学疗法，放射治疗后早期发生假性进展4例（14%)。 结论 对于TMZ同期放射、化学治疗后早期出现的影像学疑似进展，不要急于下结论，了解假性进展的临床特点，结合功能影像学检查可能会有助于临床医生的判断与处理。【Abstract】 Objective To discuss the clinical feature, diagnosis, and management of pseudoprogression after radiochemotherapy of high-grade glioma patients. Methods The clinical data of 31 high-grade glioma patients who underwent postoperative radiochemotherapy from June 2008 to June 2009 were reviewed. Pseudoprogression cases were analyzed. The treatment response was assessed through magnetic resonance imaging (MRI) according to the established response evaluation criteria in solid tumors. Results All the 31 high grade gioma patients received postoperative fractioned radiotherapy with concomitant TMZ chemotherapy, followed by TMZ maintenance chemotherapy. Four cases of pseudoprogression occurred after radiotherapy (14%). Conclusion Doctors should be careful in making early diagnosis for the suspected early progression after TMZ concomitant radiochemotherapy. It would be helpful for management to combine the clinical features of pseudoprogression with functional imaging technology.
目的:探讨CT或MRI显示占位效应及强化不明显胶质瘤的有效诊治方法。方法:19例CT或MRI检查显示无明显占位效应,并且强化均不明显,CT平扫及增强,呈低密度,MRI T1WI呈低信号,T2WI呈稍高或高信号的局限性病变。结果:10例不排除非胶质瘤,宜先观察或保守治疗半月至1月,病灶无变化,诊断仍不明确者,手术治疗;9例拟诊胶质瘤者,均作剖颅探查。19例术中发现均为实性肿瘤。其中,14例病变肉眼几乎难与正常脑组织区别,切除时感觉质地较韧,血供差;5例病变呈鱼肉状,淡肉红色,质软,血供较差,为较典型胶质瘤。位于中央沟附近3例,该3例中2例采用立体定向开颅手术,1例采用CT定位开颅手术。后者术中肉眼确定病变困难,导致术后肢体活动障碍加重,余18例疗效满意。病理检验为星形细胞瘤Ⅰ～Ⅱ级12例,少枝胶质细胞瘤2例,星形细胞瘤Ⅲ～Ⅳ级5例。结论:对于CT或MRI显示占位效应及强化不明显脑内病变,保守治疗无效者,尤位于非功能区病变者,应积极考虑开颅手术切除。对位于功能区病灶或小病灶,应采用立体定向开颅手术,避免因寻找病变困难而导致术后神经功能废损症状加重,或造成不能获得准确病检结果的不良后果。
【摘要】 目的 探讨成人幕上低级别胶质瘤（WHO Ⅱ级）患者术后生活质量的影响因素。 方法 回顾性分析2008年10月—2010年5月经手术切除病变、术后病理证实为低级别胶质瘤的115例患者临床资料，术后随访6~24个月。以患者年龄、性别、主要临床症状、病变部位、病变大小及病理结果为自变量，以术后Karnofsky评分（KPS）改善为因变量，采用Logistic回归分析研究相关影响因素。采用秩和检验比较不同组间KPS差异。 结果 随访至术后6个月，患者年龄、病变大小、病变部位、切除范围以及是否有癫痫史在KPS比较中，其结果有统计学意义（Plt;0.05）。随访至术后12个月，切除范围和癫痫史对KPS评分已无影响（Pgt;0.05）。病理类型、术前是否存在神经功能障碍与术后KPS改善在单因素和多因素比较中无统计学意义。 结论 患者年龄≤50岁、术前有癫痫史、肿瘤直径≤4 cm、病变表浅、肿瘤全切除的患者术后KPS改善好于年龄gt;50岁、术前无癫痫史、肿瘤直径gt;4 cm、病变深在、肿瘤次全切除的患者。患者术前是否存在神经功能障碍和病理类型与术后生活质量是否改善无明显关系。复发也是影响患者术后KPS改善的因素。【Abstract】 Objective To assess the quality of life in adults with surgically managed cerebral supratentorial low grade glioma (WHO grade Ⅱ) and the relevant factors. Methods We retrospectively analyzed the clinical data of 115 patients with histologically proven supratentorial low grade glioma enrolled at West China Hosptial from October 2008 to May 2010. Follow-up lasted for 6 to 24 months after operation. Logisitc regression analysis is used to test the relevant factors with age, gender, main clinical manifestations, lesion location, lesion size and pathological results as the independent variables, and Kamofsky postoperative scale (KPS) scores as dependent variable. KPS scores of different groups were analyzed using the rank test. Results After 6 months of follow-up, we found that age, size, location, extent of surgical excision and eplispy history showed a statistical significance in KPS comparison (Plt;0.05). Till the 12th month in the follow-up, the extent of surgical excision and eplispy history were not statistically significant any more (Pgt;0.05). Histology type and neurological deficit had no relationship with KPS improvement in both single factor analysis and multivariate analysis. Conclusions Patients with an age older than 50 years, preoperative epilepsy history, the largest diameter of the tumor less than 4 cm, shallow lesions, and complete tumor resection have a better KPS improvement after operation than those with corresponding opposite conditions. There is no obvious relationship between histology type, neurologic deficits and KPS improvement after operation. Recurrence is also a factor influencing KPS improvement after operation.
ObjectiveTo analyze the electro-clinical characteristics and surgical outcome of low-grade developmental tumors in temporal lobe. MethodsThe onset age, seizure duration, seizure types, electroencephalogram and surgical outcome of 49 patients with low-grade developmental tumor of temporal lobe were analyzed retrospectively. ResultsTwo groups of the seizure types were divided. The first group was spasm, the other was focal onset. There were 12 cases in spasm group, with an average onset age of (1.00±0.59) years. The discharge was extensive and multi-brain-area locaded, especially in the temporal montages and the ipsilateral posterior montages. There were 37 cases in second group, with an average onset age of (8.90±8.84) years, mainly including autonomic seizure, tonic seizure and automotor seizure. In this group, the discharge was mainly recorded in the temporal montages, which could spread to the frontal montages and less locaded in posterior montages. The difference of onset age between the two groups was statistically significant (P<0.01). The average follow-up of spasm group was (2.80±1.57) years, and the surgical outcome of all patients in this group were all Engel I (100.00%, 12/12). The focal onset group was followed up for an average of (6.50±4.78) years, and the rate of Engel I was 91.80% (34/37). There was no significant difference between the two groups (P>0.05). ConclusionsFor low-grade developmental tumors in temporal lobe, there are two seizure types, including spasm and focal onset. The onset age of spasm is earlier, while patients with focal onset mostly start at childhood or older, rare in infancy. Surgery has a good effect on the treatment of temporal lobe developmental tumor epilepsy.