用于改善人类膀胱癌预后预测的细胞核形态测定法。

Nuclear morphometry for improved prediction of the prognosis of human bladder carcinoma.

作者信息

Fukuzawa S, Hashimura T, Sasaki M, Yamabe H, Yoshida O

机构信息

Department of Urology, Faculty of Medicine, Kyoto University, Japan.

出版信息

Cancer. 1995 Nov 15;76(10):1790-6. doi: 10.1002/1097-0142(19951115)76:10<1790::aid-cncr2820761017>3.0.co;2-j.

DOI:10.1002/1097-0142(19951115)76:10<1790::aid-cncr2820761017>3.0.co;2-j

PMID:8625049

Abstract

BACKGROUND

Histologic grade and clinical stage generally are used for estimating the prognosis of bladder carcinoma. However, both methods have been reported to have a rather low reproducibility and to be unsatisfactory for predicting the recurrence and progression of superficial bladder carcinoma. Recently, nuclear morphometry was used to quantitate the malignant potential of cancer cells in a more objective and reproducible manner. The authors quantitatively analyzed the malignant potential of bladder carcinoma at initial presentation using a combination of several nuclear morphometric variables.

METHODS

The subjects were 156 patients with previously untreated bladder carcinoma. Three morphometric variables were measured in each subject: the mean nuclear volume (MNV), the nuclear roundness factor (NRF), and the variation of nuclear area (VNA).

RESULTS

Univariate analysis showed that MNV and NRF were significant prognostic indicators for survival (MNV, P < 0.0001; NRF, P = 0.008). In addition, MNV was a prognostic indicator for tumor recurrence (P = 0.001), whereas MNV and NRF were prognostic indicators for invasive progression (MNV, P = 0.02; NRF, P = 0.009). For accurate prediction of the prognosis of patients with bladder carcinoma, a prognostic score, a recurrence score, and a progression score were designed using the coefficients of MNV and NRF in a proportional hazards model. The prognostic score clearly divided the patients into two different groups with 5-year survival rates of 88% and 64% (P = 0.0002). In addition, patients with superficial bladder carcinoma and a low recurrence score had a significantly higher 5-year recurrence free rate than those with a high recurrence score (40% vs. 23%, P = 0.0004), and the 5-year progression free rate of patients with a low progression score was significantly higher than that of those with a high progression score (98% vs. 73%, P = 0.0006).

CONCLUSIONS

These findings suggest that nuclear morphometry is a reliable technique with which to identify prognostic indicators for human bladder carcinoma. A combination of several nuclear morphometric variables provides a more accurate indication of prognosis than any single parameter.

摘要

背景

组织学分级和临床分期通常用于评估膀胱癌的预后。然而，据报道这两种方法的可重复性都相当低，对于预测浅表性膀胱癌的复发和进展并不令人满意。最近，核形态计量学被用于以更客观和可重复的方式定量癌细胞的恶性潜能。作者使用几个核形态计量学变量的组合对初诊时膀胱癌的恶性潜能进行了定量分析。

方法

研究对象为156例未经治疗的膀胱癌患者。对每个研究对象测量三个形态计量学变量：平均核体积（MNV）、核圆度因子（NRF）和核面积变异（VNA）。

结果

单因素分析显示，MNV和NRF是生存的显著预后指标（MNV，P < 0.0001；NRF，P = 0.008）。此外，MNV是肿瘤复发的预后指标（P = 0.001），而MNV和NRF是侵袭性进展的预后指标（MNV，P = 0.02；NRF，P = 0.009）。为了准确预测膀胱癌患者的预后，在比例风险模型中使用MNV和NRF的系数设计了一个预后评分、一个复发评分和一个进展评分。预后评分清楚地将患者分为两个不同的组，5年生存率分别为88%和64%（P = 0.0002）。此外，浅表性膀胱癌且复发评分低的患者5年无复发率明显高于复发评分高的患者（40%对23%，P = 0.0004），进展评分低的患者5年无进展率明显高于进展评分高的患者（98%对73%，P = 0.0006）。