成人神经胶质瘤的形态发生特征(2007年、2016年、2021年WHO分类)分类的变化及其对临床的意义

V. V. Krylov, G. Yu. Evzikov, G. L. Kobyakov
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引用次数: 0

摘要

本讲座旨在分析2007年、2016年、2021年世界卫生组织(WHO)分类框架下成人神经胶质肿瘤的形态发生特征、分类的变化及其对临床实践的意义。这一主题很重要,因为与2007年、2016年和2021年的世卫组织分类相比,神经外科医生最难理解的变化涉及神经胶质肿瘤和儿童肿瘤部分。作者的重点是提高遗传成分在肿瘤表征中的实际意义。2007年的分类是最后一个纯粹的中枢神经系统肿瘤形态学分类,它不包括肿瘤在不同群体中分裂的遗传原理。在接下来的几年里,关于各种突变对神经胶质肿瘤进展的预后和基于肿瘤遗传特征选择最佳治疗的重要性的知识得到了积极的积累。在2016年的版本中,首次整合了肿瘤的形态和遗传特征,这无疑是必要的一步。神经胶质瘤基因组的复杂综合分析表明,与WHO分级相比,遗传特征具有更高的预后价值。在2021年的分类中,对2016年提出的肿瘤名称进行了修改,增加了遗传成分在肿瘤表征中的实际意义。然而,这可能进一步使神经外科医生对组织学诊断的解释复杂化。在临床实践中实施世卫组织2021年分类需要扩大遗传诊断方法的范围。神经外科社区应该准备好解释形态发生结果,并根据肿瘤的遗传特征与肿瘤学家一起选择治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Morphogenetic characteristics of glial tumors in adults per the WHO classifications of 2007, 2016, 2021. Changes in the classifications and their significance for clinical practice
The presented lecture is dedicated to analysis of morphogenetic characteristics of glial tumors in adults in the framework of the World Health Organization (WHO) classifications of 2007, 2016, 2021, changes in the classifications and their significance for clinical practice. This topic is important because the most difficult changes for neurosurgeons to understand in comparison of the WHO classifications of 2007, 2016 and 2021 involved sections on glial tumors and children’s tumors. The authors focus on increasing practical significance of genetic component in tumor characterization. The classification of 2007 was the last purely morphological classification of central nervous system tumors, it did not include genetic principles of tumor division in different groups. In the following years, knowledge on the significance of various mutations for prognosis of glial tumor progression and selection of optimal treatment based in genetic characteristics of the neoplasm has been actively accumulated. In the 2016 edition, morphological and genetic tumor characteristics were consolidated for the first time which was unquestionably a necessary step. Complex integrative analysis of glioma genomes has shown that genetic characteristics have higher prognostic value compared to the WHO Grade. In the classification of 2021, names of the tumors proposed in 2016 were changed, and practical significance of the genetic component in tumor characterization was increased. However, this can further complicate interpretation of histological diagnosis by practicing neurosurgeons. Implementation of the 2021 WHO classification in clinical practice assumes expansion of the spectrum of genetic diagnostic methods. The neurosurgical community should be ready to interpret morphogenetic results and select treatment tactics in tandem with oncologists based on genetic characteristics of the tumor.
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