Lipponen P K, Aaltomaa S
Department of Pathology, University of Kuopio, Finland.
J Pathol. 1994 Aug;173(4):333-9. doi: 10.1002/path.1711730408.
Four hundred cases of transitional cell bladder cancer were reviewed by light microscopy for the presence of apoptotic cells in the primary tumour biopsy specimens. The number of apoptotic cells/mm2 of neoplastic epithelium (apoptotic index, AI) was related to various histological features and prognosis. AI was related significantly to high T-category, high grade, DNA aneuploidy, large nuclear morphometric variable values, and high proliferation rate of cancer cells. Tumours showing overexpression of p53 oncoprotein in over 10 per cent of the nuclei had significantly higher AI values than p53-negative tumours. Multivariate regression analysis showed that AI was independently predicted by mitotic index, mean nuclear area, and papillary status. Progression, recurrence-free survival, and survival of superficial tumours were all related significantly to AI. In multivariate survival analysis, T-category, papillary status, grade, and mitotic index had independent prognostic value, while the recurrence-free survival of Ta-T1 tumours was related independently to AI. The results show that AI is related particularly to mitotic activity in transitional cell bladder tumours, while AI as assessed by light microscopy hardly has any independent prognostic significance.
对400例移行细胞膀胱癌患者的原发性肿瘤活检标本进行光学显微镜检查，以观察凋亡细胞的存在情况。肿瘤上皮每平方毫米的凋亡细胞数量（凋亡指数，AI）与各种组织学特征及预后相关。AI与高T分期、高分级、DNA非整倍体、大核形态计量变量值以及癌细胞的高增殖率显著相关。在超过10%的细胞核中显示p53癌蛋白过表达的肿瘤，其AI值显著高于p53阴性肿瘤。多变量回归分析表明，AI可由有丝分裂指数、平均核面积和乳头状状态独立预测。浅表性肿瘤的进展、无复发生存率和生存率均与AI显著相关。在多变量生存分析中，T分期、乳头状状态、分级和有丝分裂指数具有独立的预后价值，而Ta-T1肿瘤的无复发生存率则与AI独立相关。结果表明，AI尤其与移行细胞膀胱肿瘤的有丝分裂活性相关，而通过光学显微镜评估的AI几乎没有任何独立的预后意义。
