Prognostic significance of apoptosis in medulloblastoma

Since apoptosis is a major contributor to cell loss in medulloblastoma, either spontaneous or induced by radiation and chemotherapy, the apoptotic rate in resection specimens could have prognostic significance. We analysed the apoptotic rate in 58 medulloblastoma resection specimens using an antibody against cleaved caspase 3, a specific marker of apoptotic cell death, and tested its possible prognostic significance. The apoptotic rate varied considerably among medulloblastomas (0.1-25.9%, median 1.1%). Apoptotic cells were relatively evenly distributed in 39 cases, while in 19 cases, an uneven distribution with foci of an increased number of apoptotic cells and their clustering was observed. Clusters of apoptotic cells were found around necrotic areas, while necrotic cells were caspase 3 negative. The apoptotic rate was higher in medulloblastomas with CSF dissemination, tended to be higher in desmoplastic medulloblastomas, but there was no association with age group and sex. In the univariate analysis of overall survival, the apoptotic rate had no prognostic value. The variation in apoptotic rate among medulloblastomas is very likely predominantly associated with variations in tumour microenvironment, as supported by apoptotic cell clustering and rimming around necrotic areas. The apoptotic rate in medulloblastoma resection specimens does not seem to be of prognostic value.