增殖细胞核抗原免疫组化染色在滑膜肉瘤中的预后价值

The prognostic value of immunohistochemical staining for proliferating cell nuclear antigen in synovial sarcoma.

作者信息

Oda Y, Hashimoto H, Takeshita S, Tsuneyoshi M

机构信息

Second Department of Pathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.

出版信息

Cancer. 1993 Jul 15;72(2):478-85. doi: 10.1002/1097-0142(19930715)72:2<478::aid-cncr2820720225>3.0.co;2-p.

DOI:10.1002/1097-0142(19930715)72:2<478::aid-cncr2820720225>3.0.co;2-p

PMID:8100481

Abstract

BACKGROUND

The biologic behavior of synovial sarcoma remains a matter of controversy. Some investigators considered proliferative activity to be an important prognostic factor in this tumor.

METHODS

Fifty-six patients with synovial sarcoma were immunohistochemically studied with PC10, a monoclonal antibody to proliferating cell nuclear antigen (PCNA). The percentage of nuclear areas with positive staining for PCNA (PCNA score), quantified by using an image analyzer, was compared with nuclear atypia, tumor necrosis, mitoses, and survival. Fifty-one patients were available for survival analysis. DNA flow cytometry was performed on 30 patients and compared with PCNA score and survival. The prognostic variables were analyzed with a multivariate technique using the Cox hazard model.

RESULTS

Nuclear atypia (mild, 14; moderate, 23; severe, 14), mitosis (low, 34; high, 17), and tumor necrosis (< 50%, 37; > 50%, 14) were found to highly affect survival in the log-rank test (P < 0.01). Sixteen patients with a high (> or = 12.5) PCNA score had a worse survival (P < 0.01) than did the 35 patients with a low (< 12.5) PCNA score. In patients in whom DNA flow cytometry was performed, the S+G2M-phase fraction showed no correlation with the clinical outcome. However, there was a significant relationship between the extent of PCNA staining and S+G2M fraction (correlation coefficient [CC] = 0.54; P = 0.002), although the CC between PCNA staining and the mitotic count was only 0.38. However, the ploidy pattern was not related to PCNA scores or prognosis. In a multivariate analysis, a high PCNA score (P = 0.017) and severe nuclear atypia (P = 0.0003) were strong prognostic factors.

CONCLUSIONS

The results suggest that a high PCNA score is one of the poor prognostic factors in synovial sarcoma.

摘要

背景

滑膜肉瘤的生物学行为仍存在争议。一些研究者认为增殖活性是该肿瘤的一个重要预后因素。

方法

采用增殖细胞核抗原（PCNA）单克隆抗体PC10对56例滑膜肉瘤患者进行免疫组织化学研究。使用图像分析仪对PCNA阳性染色的核面积百分比（PCNA评分）进行量化，并与核异型性、肿瘤坏死、有丝分裂及生存率进行比较。51例患者可进行生存分析。对30例患者进行DNA流式细胞术检测，并与PCNA评分及生存率进行比较。采用Cox风险模型的多变量技术分析预后变量。

结果

在对数秩检验中，核异型性（轻度，14例；中度，23例；重度，14例）、有丝分裂（低，34例；高，17例）和肿瘤坏死（<50%，37例；>50%，14例）对生存率有高度影响（P<0.01）。16例PCNA评分高（≥12.5）的患者生存率低于35例PCNA评分低（<12.5）的患者（P<0.01）。在进行DNA流式细胞术检测的患者中，S+G2M期比例与临床结局无相关性。然而，PCNA染色程度与S+G2M期比例之间存在显著关系（相关系数[CC]=0.54；P=0.002），尽管PCNA染色与有丝分裂计数之间的CC仅为0.38。然而，倍体模式与PCNA评分或预后无关。多变量分析显示，PCNA评分高（P=0.017）和重度核异型性（P=0.0003）是强有力的预后因素。